Mierez, R; Guillén, A; Brell, M; Cardona, E; Claramunt, E; Costa, J M
Growing skull fractures (GSF) are rare complications of head injury (HI) in childhood. This entity consists of a skull fracture with an underlying dural tear that courses with a progressive enlargement of the fracture to produce a cranial defect. The pathophysiology and some aspects of its management are still controversial. In this review we present 12 patients diagnosedd and treated for a GSF at our institution between 1980 and 2002. 11 patients were under the age of 3 years and one patient was 5 years old at the moment of HI. The most common cause of injury was a fall from height. In the initial plain x-rayfilms, 11 patients showed a diastatic skull fracture and one patient only had a linear fracture. At this time, CT scan showed cortical contussion underlying the fracture in every case. The mean time between injury and presentation of GSF was 11.6 weeks. Diagnosis was made by palpation of the cranial defect and confirmed with skull x-rayfilms. The most frecuent location of GSF was in the parietal region. Associated lesions like hydrocephalus, encephalomalacia, lepto-menigeal cysts, brain tissue herniation and ipsilateral ventricular dilatation, were found in the preoperative CT or MRI. All patients underwent a dural repair with pericranium or fascia lata. The cranial defect was covered with local calvarial bone fragments in every case. Only one patient needed a cranioplasty with titanium mesh. Every child with a skull fracture must be followed until the fracture heals. Patients under the age of 3 years with a diastatic fracture and a dural tear, demostrated by TC or MRI, are more prone to develop GSF. In these cases, early repair must be adviced in order to prevent progressive brain damage.
Yu, Michael; Schmidt, John H; Trenton, Brooke A; Sheets, Nicholas W
Growing skull fractures are a rare complication of linear skull fractures in children. The authors report a case of a growing skull fracture in a 5-month-old patient with a review of the literature. CT and MRI scans revealed a growing skull fracture with complication of leptomeningeal cyst formation. Surgical removal of the cyst, duraplasty and cranial reconstruction were performed. Follow up showed that the patient was stable neurologically and had improving left upper extremity weakness.
Growing skull fracture is an extremely rare complication of pediatric head injury, especially in infants. Repair of the dural tear early in the course of development of growing skull fracture has been suggested for a better outcome. Surgical repair of large, tense growing skull fractures, especially those in the communication of the ventricles can lead to potentially life-threatening complications. The author reports a rare case of remote intracranial hemorrhage following surgery for large, tense growing skull fracture in a 12-year-old girl and discusses the likely pathogenesis and possible ways to avoid this life-threatening complication.
Rush, E Marie; Shores, Andrew; Meintel, Sarah; Hathcock, John T
Growing skull fractures have been reported in humans for many years, usually resulting from injury to the soft skull during the rapid growth period of an infant's life. Nestling raptors have thin, fragile skulls, a rapid growth rate, and compete aggressively for food items. Skull trauma may occur, which may lead to the development of a growing skull fracture. Growing skull fractures may be under-diagnosed in raptor rehabilitation facilities that do not have access to advanced technologic equipment. Three-dimensional (3-D) computed tomography was used to diagnose a growing skull fracture in a red-tailed hawk (Buteo jamaicensis). The lesion was surgically repaired and the animal was eventually returned to the wild. This is the first report of a growing skull fracture in an animal. In this case, 3-D computed topographic imaging was utilized to diagnose a growing skull fracture in a red-tailed hawk, surgical repair was performed, and the bird recovered completely and was ultimately released.
Moudrous, Walid; Boogaarts, Hieronymus D; Grotenhuis, J André
We present a case of a growing skull fracture in adult male, with an interval of 43 years after initial trauma. This finding is extremely rare, especially because growing skull fractures are mostly seen as an uncommon complication of pediatric head trauma with calvarial fracture. In our patient, this finding was incidental, existed for many years, and had no clinical consequences. Therefore, we advised a conservative treatment for our patient.
... compress the underlying brain tissue (subdural or epidural hematoma). A simple fracture is a break in the bone without damage ... Causes of skull fracture can include: Head trauma Falls, automobile accidents, physical assault, and sports
Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent ... or blow can result in fracture of the skull and may be accompanied by injury to the ...
Villarejo, F; Pascual Castroviejo, I; Dabdoub, C; Bordes, M; Jover, P
A case of growing skull fracture secondary to a maxilofacial operation is reported. Frequency, clinical symptoms, phisiopathology and treatment of growing skull fractures are reviewed and the rarity of the iatrogenic mechanism is stressed.
gunshot wounds to the skull and direction of fire. J Forensic Sci 1982;27:555-66. 3. Berryman HE, Gunther WM. Keyhole defect production in tubular bone.J...Keyhole Fracture of the Skull Radiology Corner Keyhole Fracture of the Skull Guarantor...abbreviated answer in the December 2008 issue. 1 The authors present the case of a soldier wounded in Iraq with a gunshot wound to the skull
Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy
A composite material model for skull, taking into account damage is implemented in the Strasbourg University finite element head model (SUFEHM) in order to enhance the existing skull mechanical constitutive law. The skull behavior is validated in terms of fracture patterns and contact forces by reconstructing 15 experimental cases. The new SUFEHM skull model is capable of reproducing skull fracture precisely. The composite skull model is validated not only for maximum forces, but also for lateral impact against actual force time curves from PMHS for the first time. Skull strain energy is found to be a pertinent parameter to predict the skull fracture and based on statistical (binary logistical regression) analysis it is observed that 50% risk of skull fracture occurred at skull strain energy of 544.0mJ.
Wiedijk, J E F; Soerdjbalie-Maikoe, V; Maat, G J R; Maes, A; van Rijn, R R; de Boer, H H
This paper describes an investigation of the sudden and unexpected death of a five-and-a-half-month-old boy. As in every Dutch case of sudden unexpected death in infancy (SUDI), a multidisciplinary diagnostic approach was used. This included post-mortem radiography, showing a linear discontinuity of the parietal bone. Originally this was interpreted as a skull fracture, but autopsy indicated no signs of mechanical trauma. Instead the defect was defined as a unilateral accessory suture of the parietal bone. The initial erroneous diagnosis had severe adverse consequences and thus every health care professional or forensic specialist dealing with paediatric mechanical traumas should be cautious of this rare anomaly.
Yildirim, Altan; Gurelik, Mustafa; Gumus, Cesur; Kunt, Tanfer
This report describes a pediatric case of delayed glossopharyngeal nerve, vagus nerve, and facial nerve palsies after a head injury. Computed tomography scan of the skull base revealed the fracture of the petrous part of the temporal bone, and the fracture involved the tip of petrous pyramid, in front of the jugular foramen. The anatomical features, mechanisms, diagnosis, and treatment are discussed.
San Martín-García, Isabel; Aguilera-Albesa, Sergio; Zazpe-Cenoz, Idoya; Yoldi-Petri, M Eugenia
Introduccion. La fractura craneal evolutiva, tambien llamada absorcion osea postraumatica o quiste leptomeningeo, es una rara complicacion de los traumatismos craneoencefalicos y ocurre de forma casi exclusiva en ninos menores de 3 anos. Caso clinico. Nino de 6 meses que presentaba, dos meses despues de un traumatismo craneal aparentemente banal, persistencia de cefalohematoma temporooccipital izquierdo sin otros signos. El estudio de ecografia transfontanelar revelo un defecto oseo con herniacion cerebral, y la tomografia computarizada y la resonancia magnetica confirmaron, ademas, una fractura evolutiva. Se realizo reseccion del quiste encefalomeningeo, cierre dural y reparacion del defecto oseo con placas y material de lactato. Tres meses despues de la intervencion, presentaba persistencia de coleccion liquida y se confirmo recidiva de la fractura evolutiva. Tras la reintervencion, se coloco casco ortesico para evitar nuevas recidivas. Un ano despues del traumatismo, el paciente continua asintomatico. Conclusiones. Todo nino menor de 3 anos con cefalohematoma postraumatico deberia ser revisado de forma periodica hasta comprobar la resolucion de la coleccion, en particular si presenta fractura craneal. La presencia de un cefalohematoma persistente mas de dos semanas despues de un traumatismo craneoencefalico debe hacernos sospechar un proceso de fractura creciente, y son necesarias la reparacion de la duramadre y una craneoplastia para su tratamiento. La colocacion de material reabsorbible permite su remodelacion con el crecimiento craneal del paciente, pero su fragilidad conlleva riesgo de recidiva. La colocacion de un casco ortesico tras la intervencion podria prevenir complicaciones.
Hosaka, Ai; Yamaguchi, Tetsuto; Yamamoto, Fumiko; Shibagaki, Yasuro
Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. PMID:26693366
Thollon, Lionel; Llari, Maxime; André, Lucile; Adalian, Pascal; Leonetti, Georges; Piercecchi-Marti, Marie-Dominique
In forensic research, biomechanical analyses of falls are widely reported. However, no study on falls consecutive to uncontrolled hanging release, when a hanging body is cut down, has ever been published. In such cases, the presence of cranial trauma can raise interpretation issues, and there may be doubt as to whether the fall was an accident or a crime disguised as suicide. The problem remains as to whether or not a fall after a free hanging release can lead to a skull fracture. To address this question, numerical simulations, post-mortem human subject tests and parametric studies were performed. We first recreated the kinematics and velocity of this atypical fall with post-mortem human subject tests and multibody simulations. We then tested the influence of biological variability on fracture production using a finite element model of the head. Our results show that fall severity depends largely on the direction of the fall. The risk of fracture is highest in the occipital region and with a backward fall. Our study also highlights the frequent occurrence of lower limb trauma in a free hanging release. Most importantly, we show that a fracture is produced in only 3.4% of falls that occur in a 10-90 cm height range. The overall findings of this study provide tools for pathologists and magistrates to decide on the most likely scenario and to justify further forensic investigations if required.
Wiersema, Jason M; Love, Jennifer C; Derrick, Sharon M; Pinto, Deborrah C; Donaruma-Kwoh, Marcella; Greeley, Christopher S
The literature pertaining to pediatric skull fracture is primarily clinically based and thus motivated by the need for effective assessment of both fracture characteristics (type, frequency, location, and mechanics) and context (severity of injury, associated soft tissue damage, and prognosis). From a strictly descriptive standpoint, these schemas employ overlapping levels of detail that confound the nonclinical description of fractures in the forensic context. For this reason, application of these schemas in the forensic anthropological interpretation of skull fractures is inappropriate. We argue that forensic anthropological interpretation of skull fractures requires a standard classification system that reflects fracture morphology alone, and we suggest a three-stepped classification system that conveys increasing detail with each additional step. A retrospective application of the method to a sample of 31 children aged 1 month to 2 years demonstrated its efficacy in the description of pediatric skull fractures.
Soucy, Zachary P; Mills, Lisa; Rose, John S; Kelley, Kenneth; Ramirez, Francisco; Kuppermann, Nathan
Over the past decade, point-of-care ultrasound has become a common tool used for both procedures and diagnosis. Developing high-fidelity phantoms is critical for training in new and novel point-of-care ultrasound applications. Detecting skull fractures on ultrasound imaging in the younger-than-2-year-old patient is an emerging area of point-of-care ultrasound research. Identifying a skull fracture on ultrasound imaging in this age group requires knowledge of the appearance and location of sutures to distinguish them from fractures. There are currently no commercially available pediatric skull fracture models. We outline a novel approach to building a cost-effective, simple, high-fidelity pediatric skull fracture phantom to meet a unique training requirement.
Ieva, Antonio Di; Audigé, Laurent; Kellman, Robert M.; Shumrick, Kevin A.; Ringl, Helmut; Prein, Joachim; Matula, Christian
The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units, including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 and more detailed level 3 systems for the skull base and cranial vault units. The level 2 system describes fracture location outlining the topographic boundaries of the anatomic regions, considering in particular the endocranial and exocranial skull base surfaces. The endocranial skull base is divided into nine regions; a central skull base adjoining a left and right side are divided into the anterior, middle, and posterior skull base. The exocranial skull base surface and cranial vault are divided in regions defined by the names of the bones involved: frontal, parietal, temporal, sphenoid, and occipital bones. The level 3 system allows assessing fracture morphology described by the presence of fracture fragmentation, displacement, and bone loss. A documentation of associated intracranial diagnostic features is proposed. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical skull base and cranial vault regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. PMID:25489394
Hart, Gina O
There have been several anthropological studies on trauma analysis in recent literature, but few studies have focused on the differences between the three mechanisms of trauma (sharp force trauma, blunt force trauma and ballistics trauma). The hypothesis of this study is that blunt force and ballistics fracture patterns in the skull can be differentiated using concentric fractures. Two-hundred and eleven injuries from skulls exhibiting concentric fractures were examined to determine if the mechanism of trauma could be determined by beveling direction. Fractures occurring in buttressed and non-buttressed regions were examined separately. Contingency tables and Pearson's Chi-Square were used to evaluate the relationship between the two variables (the mechanism of trauma and the direction of beveling), while Pearson's r correlation was used to determine the strength of the relationship. Contingency tables and Chi-square tests among the entire sample, the buttressed areas, and the non-buttressed areas led to the null hypothesis (no relationship) to be rejected. Pearson's r correlation indicated that the relationship between the variables studied is greater than chance allocation.
Delannoy, Yann; Becart, Anne; Colard, Thomas; Delille, Rémi; Tournel, Gilles; Hedouin, Valéry; Gosset, Didier
The lesions of the skull following perforating traumas can create complex fractures. The blunt traumas can, according to the swiftness and the shape of the object used, create a depressed fracture. The authors describe through two clinical cases the lesional characteristic of the blunt traumas, perforating the skull using a hammer. In both cases the cranial lesions were very typical: they were geometrical, square shaped, of the same size than the tool (head and tip of the hammer). On the outer table of the skull, the edges of the wounds were sharp and regular. On the inner table, the edges of the wounds were beveled and irregular. The bony penetration in the depressed fracture results from a rupture of the outer table of the bone under tension, in periphery, by the bend of the bone to the impact (outbending) and then, from the inner table with comminuted bony fragmentation. Breeding on the fractures of the size and the shape of the blunt objects used is inconstant and differs, that it is the objects of flat surface or wide in opposition to those of small surface area. Fractures morphologies depend on one hand on these extrinsic factors and on the other hand, of intrinsic factors (structure of the bone). To identify them, we had previously conducted experimental work on cranial bone samples. The bone was submitted to a device for three-point bending. This work had shown properties of thickness and stiffness of the various areas of the vault. Our cases are consistent with these results and illustrate the variability of bone lesions according to region and mode of use of blunt weapons. Many studies have identified criteria for identification of the weapons and the assistance of digital and biomechanical models will be an invaluable contribution with this aim in the future.
White, Ian K; Pestereva, Ecaterina; Shaikh, Kashif A; Fulkerson, Daniel H
OBJECTIVE Children with skull fractures are often transferred to hospitals with pediatric neurosurgical capabilities. Historical data suggest that a small percentage of patients with an isolated skull fracture will clinically decline. However, recent papers have suggested that the risk of decline in certain patients is low. There are few data regarding the financial costs associated with transporting patients at low risk for requiring specialty care. In this study, the clinical outcomes and financial costs of transferring of a population of children with isolated skull fractures to a Level 1 pediatric trauma center over a 9-year period were analyzed. METHODS A retrospective review of all children treated for head injury at Riley Hospital for Children (Indianapolis, Indiana) between 2005 and 2013 was performed. Patients with a skull fracture were identified based on ICD-9 codes. Patients with intracranial hematoma, brain parenchymal injury, or multisystem trauma were excluded. Children transferred to Riley Hospital from an outside facility were identified. The clinical and radiographic outcomes were recorded. A cost analysis was performed on patients who were transferred with an isolated, linear, nondisplaced skull fracture. RESULTS Between 2005 and 2013, a total of 619 pediatric patients with isolated skull fractures were transferred. Of these, 438 (70.8%) patients had a linear, nondisplaced skull fracture. Of these 438 patients, 399 (91.1%) were transferred by ambulance and 39 (8.9%) by helicopter. Based on the current ambulance and helicopter fees, a total of $1,834,727 (an average of $4188.90 per patient) was spent on transfer fees alone. No patient required neurosurgical intervention. All patients recovered with symptomatic treatment; no patient suffered late decline or epilepsy. CONCLUSIONS This study found that nearly $2 million was spent solely on transfer fees for 438 pediatric patients with isolated linear skull fractures over a 9-year period. All patients
Walshe, Keryn; Brophy, Brian; Cornish, Brian; Byard, Roger W
The skeletal remains of eight Australian Aboriginals with healed depressed skull fractures were examined. Male:female ratio 5:3; age range 20-60 yrs. Burial dates by (14) C dating in three cases were 500 years BP (n = 2) and 1300 BP. There were 13 healed depressed skull fractures manifested by shallow indentations of cortical bone and thinning of diploe, with no significant disturbance of the inner skull tables. Nine (69%) were located within 35 mm of the sagittal suture/midline. These lesions represent another acquired feature that might be helpful in suggesting that a skull is from a tribal Aboriginal individual and may be particularly useful if the remains are represented by only fragments of calvarium. While obviously not a finding specific to this population, these healed injuries would be consistent with the possible results of certain types of conflict behavior reported in traditional Aboriginal groups that involved formalized inflicted blunt head trauma.
Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy
The objective of this study was to enhance an existing finite element (FE) head model with composite modeling and a new constitutive law for the skull. The response of the state-of-the-art FE head model was validated in the time domain using data from 15 temporo-parietal impact experiments, conducted with postmortem human surrogates. The new model predicted skull fractures observed in these tests. Further, 70 well-documented head trauma cases were reconstructed. The 15 experiments and 70 real-world head trauma cases were combined to derive skull fracture injury risk curves. The skull internal energy was found to be the best candidate to predict skull failure based on an in depth statistical analysis of different mechanical parameters (force, skull internal energy), head kinematic-based parameter, the head injury criterion (HIC), and skull fracture correlate (SFC). The proposed tolerance limit for 50% risk of skull fracture was associated with 453mJ of internal energy. Statistical analyses were extended for individual impact locations (frontal, occipital and temporo-parietal) and separate injury risk curves were obtained. The 50% risk of skull fracture for each location: frontal: 481mJ, occipital: 457mJ, temporo-parietal: 456mJ of skull internal energy.
Zhu, Bao Li; Quan, Li; Ishida, Kaori; Taniguchi, Mari; Oritani, Shigeki; Fujita, Masaki Q; Maeda, Hitoshi
This report describes an autopsy case of a rare longitudinal brainstem laceration associated with complex basilar skull fractures. The victim was a 40-year-old male who died immediately after falling from a roof (9.2m in height) of a factory onto a concrete floor. The postmortem examination revealed an incomplete ring fracture of the base of the skull with longitudinal fractures of the sphenoid (clivus of the dorsum sellae turcicae) and occipital bones, cerebral contusions in the frontal and temporal poles, a longitudinal brainstem laceration at the posterior median sulcus of the pons accompanied with multiple contusional hemorrhages in the brainstem and corpus callosum. Related blunt-force injuries were observed in the parieto-occipital region of the head, shoulder and upper back involving the fractures of the cervical and thoracic vertebrae, and sternum and ribs, indicating a huge impact to the occiput and subsequent impression of the vertebral column into the base of the skull due to violent anteroflexion of the neck, which caused the complex basilar skull fractures, contusions and longitudinal laceration of the brainstem.
Lee, Anselm C. W.; Ou, Yvonne; Fong, Dawson
Objective: To describe a pattern of abusive head injury in a series of children older than 4 years of age. Methods: A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described. Results: An 11-year-old girl and a pair…
Perdekamp, Markus Grosse; Kneubuehl, Beat P; Ishikawa, Takaki; Nadjem, Hadi; Kromeier, Jan; Pollak, Stefan; Thierauf, Annette
Apart from one article published by Rabl and Sigrist in 1992 (Rechtsmedizin 2:156-158), there are no further reports on secondary skull fractures in shots from captive bolt guns. Up to now, the pertinent literature places particular emphasis on the absence of indirect lesions away from the impact point, when dealing with the wounding capacity of slaughterer's guns. The recent observation of two suicidal head injuries accompanied by skull fractures far away from the bolt's path gave occasion to experimental studies using simulants (glycerin soap, balls from gelatin) and skull–brain models. As far as ballistic soap was concerned, the dimensions of the bolt's channel were assessed by multi-slice computed tomography before cutting the blocks open. The test shots to gelatin balls and to skull-brain models were documented by means of a high-speed motion camera. As expected, the typical temporary cavity effect of bullets fired from conventional guns could not be observed when captive bolt stunners were discharged. Nevertheless, the visualized transfer of kinetic energy justifies the assumption that the secondary fractures seen in thin parts of the skull were caused by a hydraulic burst effect.
Asgharpour, Z; Baumgartner, D; Willinger, R; Graw, M; Peldschus, S
Traumatic head injuries can result from vehicular accidents, sports, falls or assaults. The current advances in computational methods and the detailed finite element models of the human head provide a significant opportunity for biomechanical study of human head injuries. The biomechanical characteristics of the human head through head impact scenarios can be studied in detail by using the finite element models. Skull fracture is one of the most frequent occurring types of head injuries. The purpose of this study is to analyse the experimental head impacts on cadavers by means of the Strasbourg University Finite Element Head Model (SUFEHM). The results of the numerical model and experimental data are compared for validation purpose. The finite element model has also been applied to predict the skull bone fracture in frontal impacts. The head model includes the scalp, the facial bone, the skull, the cerebral spinal fluid, the meninges, the cerebrum and the cerebellum. The model is used to simulate the experimental frontal head impact tests using a cylindrical padded impactor. Results of the computational simulation shows that the model correlated well with a number of experimental data and a global fracture pattern has been predicted well by the model. Therefore the presented numerical model could be used for reconstruction of head impacts in different impact conditions also the forensic application of the head model would provide a tool for investigation of the causes and mechanism of head injuries.
Kim, Jiha; Kim, Choonghyo; Ryu, Young-Joon
Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema. PMID:27226867
Gitto, Lorenzo; Arunkumar, Ponni; Maiese, Aniello; Bolino, Giorgio
Skull fractures occur when forces striking the head exceed the mechanical integrity of the calvarium. A depressed skull fracture is a break in a cranial bone with depression of the bone into the brain. A depressed fracture may be open (compound), with a skin laceration over the fracture, or closed (simple), when the overlying tissue is not disrupted. The association between simple depressed fracture of the skull and elderly is rare. Paget disease of the bone is a chronic disease characterized by the deposition of abnormal bone tissue, more fragile than normal bone. We report a case of a 92-year-old man who was found supine on the floor in his residence, showing multiple signs of trauma. X-rays and computed tomography scans were performed, showing a simple depressed skull fracture on the right occipital-temporal area and even the characteristics of Paget disease of the skull. The first hypothesis was death due to voluntary homicide. A detailed study of clinical reports, laboratory tests, radiograph scans, and post mortem examination data allowed us to reconstruct the event. Death was finally ruled due to a mild passive trauma, suggesting the unlawful killing of a human without criminal intent, meaning involuntary manslaughter.
Skull fractures and cephalhematoma in newborns belong to the group of birth injuries of the head and neck, accounting for 11.4 to 15% of the total number of birth injuries. We presented a fracture of the parietal bones in a newborn, associated with parietal cephalhematoma. The newborn had transient and mild neurological symptoms: vomiting and changes in muscle tone. Clinical examination confirmed a positive "ping-pong" phenomen, craniogram confirmed the fracture of parietal bones and shown cephalhematoma, as well as ultrasound (US) examinations of the brain showed peri-interventricular bleeding grade II. After the disappearance of all clinical symptoms in a newborn, we observed total bone healing at the end of the second week of life, and good perinatal outcome. Successful recovery from injury contributes to the ability of rapid bone modeling and remodeling, and brain plasticity. Further interdisciplinary monitoring is very important.
Barras, Christen D.; Looby, Seamus; Brennan, Paul; Kok, Hong Kuan
The severity of seizures presenting to the emergency department ranges from benign to life threatening. There are also a wide number of possible etiologies. Computed tomography (CT) emergency imaging may be required at presentation to elucidate a possible cause and assess signs of intracranial trauma. This case describes a serious seizure episode in a young man while on holiday. A CT brain showed a skull fracture as a consequence of seizure-related head trauma but unexpectedly there were image findings consistent with encephalocraniocutaneous lipomatosis. The important radiological features of encephalocraniocutaneous lipomatosis and a differential diagnosis are presented. PMID:27882255
Chattopadhyay, Saurabh; Tripathi, Chandrabhal
Abstract: Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. Methods: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. Results: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. Conclusions: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases. PMID:21483205
Marsh, Nigel V; Whitehead, Gabrielle
A group of 19 children, who had received a skull fracture during infancy, were assessed at least 5 years following injury. The majority of the group (89%) had received a mild traumatic brain injury (TBI), with the remaining two (11%) having a moderate injury. The neuropsychological, academic, and psychosocial functioning of the TBI group was compared to that of 20 orthopedic subjects. The two groups were matched on the variables of gender, age, and socio-economic status. The TBI group was impaired on tests of visual attention and memory for faces. The two groups did not differ significantly on measures of language, sensorimotor functions, or visuospatial functioning. There were no statistically significant differences between the two groups on academic performance, or parent and teacher reports of psychosocial functioning. It is concluded that while there is an absence of deficits in the vast majority of functions, skull fracture in infancy can result in enduring impairment in specific cognitive skills related to the processing of complex nonverbal stimuli.
Mazzola, Riccardo F; Mazzola, Isabella C
Jacopo Berengario was born in Carpi, a medieval city close to Modena (northern Italy), circa 1460. He studied medicine at Bologna University and, in 1489, graduated in philosophy and medicine. He was appointed lecturer in anatomy and surgery at the same university, a position that he maintained for 24 years. Between 1514 and 1523, Berengario published some important anatomic and surgical works, which gave considerable fame to him.Commentaria... supra Anatomiam Mundini (Commentary... on the Anatomy of Mondino), published in 1521, constitutes the first example of an illustrated anatomic textbook ever printed. The anatomic illustrations were intended for explaining the text. Artistically speaking, the plates are typical examples of the Renaissance period and worthy of the greatest consideration.De Fractura Calvae sive Cranei (On Fracture of the Calvaria or Cranium), published in Bologna in 1518, is the first treatise devoted to head injuries ever printed. It is a landmark in the development of cranial surgery that went through numerous editions. The text was prepared in 2 months and dedicated to Lorenzo de' Medici, Duke of Urbino, who experienced a skull injury in the occipital region. Berengario wanted to demonstrate to other physicians his knowledge of anatomy and his expertise on the brain and head traumas. The book includes the illustration of an entire surgical kit or a corpus instrumentorum for performing cranial operations, which appeared for the first time in a printed book. However, Berengario's highly commendable aim was to indicate to the reader the step-by-step procedure of craniotomy for management of skull fractures along with the sequential use of the previously presented instruments.
Chida, Kohei; Yukawa, Hirotsugu; Mase, Tomohiko; Endo, Hideo; Ogasawara, Kuniaki
A 4-month-old girl fell off a table onto the floor. Computed tomography performed 4 hours after the trauma showed a left parietal epidural hematoma (EDH) with an omega-shaped fracture line in the left parietal region. The EDH was enlarged after another 4 hours. However, the EDH showed drainage into the subgaleal space through the skull fracture 2 days after the trauma and was almost completely discharged into the subgaleal space by 5 days after trauma. Both the EDH and the subgaleal hematoma had resolved completely by 12 days after the trauma. No symptoms or signs were observed during the course. This case suggests that EDH can drain slowly and spontaneously into the subgaleal space through a skull fracture in an infant.
Viel, Guido; Cecchetto, Giovanni; Manara, Renzo; Cecchetto, Attilio; Montisci, Massimo
Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.
Solomons, Joyce; Coucke, Paul; Symoens, Sofie; Cohen, Marta C; Pope, F Michael; Wagner, Bart E; Sobey, Glenda; Black, Rebecca; Cilliers, Deirdre
Dermatosparaxis Ehlers-Danlos syndrome (or EDS VIIC), a rare autosomal recessive connective tissue disorder, is characterized by extreme skin fragility, premature rupture of membranes in pregnancy, and spontaneous rupture of internal organs. Here we report a second patient with EDS VIIC presenting with congenital skull fractures and skin lacerations at birth, complications which may occur more frequently than previously thought in this condition. We also discuss the role of prenatal diagnosis in the management of a subsequent normal pregnancy.
Li, Zhigang; Liu, Weiguo; Zhang, Jinhuan; Hu, Jingwen
Skull fracture is one of the most common pediatric traumas. However, injury assessment tools for predicting pediatric skull fracture risk is not well established mainly due to the lack of cadaver tests. Weber conducted 50 pediatric cadaver drop tests for forensic research on child abuse in the mid-1980s (Experimental studies of skull fractures in infants, Z Rechtsmed. 92: 87-94, 1984; Biomechanical fragility of the infant skull, Z Rechtsmed. 94: 93-101, 1985). To our knowledge, these studies contained the largest sample size among pediatric cadaver tests in the literature. However, the lack of injury measurements limited their direct application in investigating pediatric skull fracture risks. In this study, 50 pediatric cadaver tests from Weber's studies were reconstructed using a parametric pediatric head finite element (FE) model which were morphed into subjects with ages, head sizes/shapes, and skull thickness values that reported in the tests. The skull fracture risk curves for infants from 0 to 9 months old were developed based on the model-predicted head injury measures through logistic regression analysis. It was found that the model-predicted stress responses in the skull (maximal von Mises stress, maximal shear stress, and maximal first principal stress) were better predictors than global kinematic-based injury measures (peak head acceleration and head injury criterion (HIC)) in predicting pediatric skull fracture. This study demonstrated the feasibility of using age- and size/shape-appropriate head FE models to predict pediatric head injuries. Such models can account for the morphological variations among the subjects, which cannot be considered by a single FE human model.
Vender, John R; Bierbrauer, Karin
Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary. The authors present the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed.
Missinne, Stefaan J
The author discusses a previously unknown early sixteenth-century renaissance handmade anatomical miniature skull. The small, naturalistic skull made from an agate (calcedonia) stone mixture (mistioni) shows remarkable osteologic details. Dr. Saban was the first to link the skull to Leonardo. The three-dimensional perspective of and the search for the senso comune are discussed. Anatomical errors both in the drawings of Leonardo and this skull are presented. The article ends with the issue of physiognomy, his grotesque faces, the Perspective Communis and his experimenting c. 1508 with the stone mixture and the human skull. Evidence, including the Italian scale based on Crazie and Braccia, chemical analysis leading to a mine in Volterra and Leonardo's search for the soul in the skull are presented. Written references in the inventory of Salai (1524), the inventory of the Villa Riposo (Raffaello Borghini 1584) and Don Ambrogio Mazenta (1635) are reviewed. The author attributes the skull c. 1508 to Leonardo da Vinci.
Mahoney, P F; Carr, D J; Delaney, R J; Hunt, N; Harrison, S; Breeze, J; Gibb, I
Ballistic head injury remains a significant threat to military personnel. Studying such injuries requires a model that can be used with a military helmet. This paper describes further work on a skull-brain model using skulls made from three different polyurethane plastics and a series of skull 'fills' to simulate brain (3, 5, 7 and 10% gelatine by mass and PermaGel™). The models were subjected to ballistic impact from 7.62 × 39 mm mild steel core bullets. The first part of the work compares the different polyurethanes (mean bullet muzzle velocity of 708 m/s), and the second part compares the different fills (mean bullet muzzle velocity of 680 m/s). The impact events were filmed using high speed cameras. The resulting fracture patterns in the skulls were reviewed and scored by five clinicians experienced in assessing penetrating head injury. In over half of the models, one or more assessors felt aspects of the fracture pattern were close to real injury. Limitations of the model include the skull being manufactured in two parts and the lack of a realistic skin layer. Further work is ongoing to address these.
Sharkey, E J; Cassidy, M; Brady, J; Gilchrist, M D; NicDaeid, N
Post-mortem examination is often relied upon in order to determine whether a suspicious death was natural, accidental, suicidal or homicidal. However, in many cases the mechanism by which a single injury has been inflicted cannot be determined with certainty based on pathological examination alone. Furthermore the current method of assessing applied force relating to injury is restricted to an arbitrary and subjective scale (mild, moderate, considerable, or severe). This study investigates the pathophysiological nature of head injuries caused by blunt force trauma, specifically in relation to the incidence and formation of a laceration. An experimental model was devised to assess the force required to cause damage to the scalp and underlying skull of porcine specimens following a single fronto-parietal impact. This was achieved using a drop tower equipped with adapted instrumentation for data acquisition. The applied force and implement used could be correlated with resultant injuries and as such aid pathological investigation in the differentiation between falls and blows. Experimentation revealed prevalent patterns of injury specific to the reconstructed mechanism involved. It was found that the minimum force for the occurrence of a laceration was 4,000 N.
Kolesnikov, A O; Shadymov, A B; Sarkisian, B A
Fractures in bones of the skull base (BSB) are preconditioned by the contact zone of interaction between the two below surfaces, i.e. the trace-forming one (object) and the trace-receiving one (bone). On the basis of their independent research, the authors suggest a set of criteria for the expert evaluation of fractures in BSB for the purpose of specifying the properties of the trauma-causing object, which is made with due regard for the anatomic specific features of the trauma zone.
Kumar, K; Mogha, I V; Aithal, H P; Kinjavdekar, P; Singh, G R; Pawde, A M; Kushwaha, R B
A retrospective study was undertaken to record the occurrence and pattern of long bone fractures, and the efficacy of Intramedullary (IM) Steinmann pin fixing in growing dogs. All the records of growing dogs during a 10-year-period were screened to record the cause of trauma, the age and sex of the animal, the bone involved, the type and location of the fracture, the status of fixation, alignment, maintenance of fixation and fracture healing. The results were analysed and comparisons were made between growing dogs with normal and osteopenic bones. Among the 310 cases of fractures recorded, the bones were osteopenic in 91 cases (29%). Minor trauma was the principal cause of fracture in dogs with osteopenia (25%), and indigenous breeds were most commonly affected (38%). Fractures in dogs with osteopenic bones were most commonly recorded in the age group of 2-4 months (53%), whereas fractures in normal dogs were almost equally distributed between 2 and 8 months of age. Male dogs were affected significantly more often in both groups. In osteopenic bones, most fractures were recorded in the femur (56%), and they were distributed equally along the length of the bone. Whereas in normal bones, fractures were almost equally distributed in radius/ulna, femur and tibia, and were more often recorded at the middle and distal third of long bones. Oblique fractures were most common in both groups; however, comminuted fractures were more frequent in normal bones, whereas incomplete fractures were more common in osteopenic bones. Ninety-nine fracture cases treated with IM pinning (66 normal, 33 osteopenic) were evaluated for the status of fracture reduction and healing. In a majority of the cases (61%) with osteopenic bones, the diameter of the pin was relatively smaller than the diameter of the medullary cavity (<70-75%), whereas in 68% of the cases in normal bones the pin diameter was optimum. The status of fracture fixing was satisfactory to good in significantly more
The skull is anterior to the spinal column and is the bony structure that encases the brain. Its purpose ... the facial muscles. The two regions of the skull are the cranial and facial region. The cranial ...
Slesnick, Irwin L.
Disguises a lesson about skulls with some fun to cause less fear among students. Outlines strategies, questions, and answers for use. Includes a skull mask which can be photocopied and distributed to students as a learning tool and a fun Halloween treat. Also shown is a picture of skull parts. (RT)
Shaoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy
The objective of this study was to determine the responses of 5th-percentile female, and 50th- and 95th-percentile male human heads during lateral impacts at different velocities and determine the role of the stiffness and shape of the impacting surface on peak forces and derived skull fracture metrics. A state-of-the-art validated finite element (FE) head model was used to study the influence of different population human heads on skull fracture for lateral impacts. The mass of the FE head model was altered to match the adult size dummies. Numerical simulations of lateral head impacts for 45 cases (15 experiments×3 different population human heads) were performed at velocities ranging from 2.4 to 6.5m/s and three impacting conditions (flat and cylindrical 90D; and flat 40D padding). The entire force-time signals from simulations were compared with experimental mean and upper/lower corridors at each velocity, stiffness (40 and 90 durometer) and shapes (flat and cylindrical) of the impacting surfaces. Average deviation of peak force from the 50th male to 95th male and 5th female were 6.4% and 10.6% considering impacts on the three impactors. These results indicate hierarchy of variables which can be used in injury mitigation efforts.
Wang, Xin; Zou, Lejun; Shen, Xiaohua; Ren, Yupeng; Qin, Yi
Conventional manual surveys of rock mass fractures usually require large amounts of time and labor; yet, they provide a relatively small set of data that cannot be considered representative of the study region. Terrestrial laser scanners are increasingly used for fracture surveys because they can efficiently acquire large area, high-resolution, three-dimensional (3D) point clouds from outcrops. However, extracting fractures and other planar surfaces from 3D outcrop point clouds is still a challenging task. No method has been reported that can be used to automatically extract the full extent of every individual fracture from a 3D outcrop point cloud. In this study, we propose a method using a region-growing approach to address this problem; the method also estimates the orientation of each fracture. In this method, criteria based on the local surface normal and curvature of the point cloud are used to initiate and control the growth of the fracture region. In tests using outcrop point cloud data, the proposed method identified and extracted the full extent of individual fractures with high accuracy. Compared with manually acquired field survey data, our method obtained better-quality fracture data, thereby demonstrating the high potential utility of the proposed method.
Gürbüz, Mehmet Sabri; Akmil, Mehmet Ufuk; Akar, Ezgi; Aker, Fügen Vardar
A 63-year-old man presented with a 4-month history of a slowly growing soft mass at his right parieto-occipital region. Neuroradiological examinations revealed an osteolytic extradural tumour of the skull vault. The outer and inner tables of the skull were partially destroyed by the tumour, but the dura was not involved. The tumour and the invaded bone were totally removed and the skull defect was reconstructed using the outer table of the adjacent intact skull. Histopathological examination confirmed plasmocytoma. Laboratory investigations revealed no systemic myelomatosis. It is very important to differentiate solitary plasmocytoma from systemic myelomatosis since their treatment and prognosis are different. Although the prognosis of solitary plasmocytoma is good, regular follow-up examinations are required for any possibility to progress to systemic myelomatosis.
Hu, Y; Yang, H-f; Li, S; Chen, J-z; Luo, Y-w; Yang, C
Unilateral fracture of the condylar neck in immature subjects might lead to mandible asymmetry and condyle remodelling. A rat model was used to investigate mandibular deviation and condylar remodelling associated with condyle fracture. 72 4-week-old male rats were randomly divided into three groups: an experimental group (unilateral transverse condylar fracture induced surgically), a sham operation group (surgical exposure but no fracture), and a non-operative control group (no operation). The rats were killed at intervals up to 9weeks after surgery, and outcomes were assessed using various measures of mandible deviation, histological and X-ray observation, and immunohistochemical measures of expression levels of connective tissue growth factor (CTGF) and type II collagen (Col II). The fracture led to the degeneration of mandibular size, associated with atrophy of fractured condylar process. Progressive remodelling of cartilage and increasing expression levels of CTGF and Col II were found. The authors conclude that condylar fracture can lead to asymmetries in mandible and condyle remodelling and expression of CTGF and Col II in condylar cartilage on both the ipsilateral and the contralateral sides.
Buller, Leonard T; Lawrie, Charles M; Vilella, Fernando E
Acetabular fractures in the elderly are most frequently the result of low-energy trauma and present unique management challenges to orthopedic surgeons. Evaluation and treatment should be performed in a multidisciplinary fashion with early involvement of internal medicine subspecialists and geriatricians. Distinct fracture patterns and pre-existing osteoarthritis and osteoporosis necessitate careful preoperative planning. The role of total hip arthroplasty should also be considered when surgical treatment is indicated. The outcomes of acetabular fractures in the elderly have improved, but complications remain higher and results less satisfactory than in younger individuals. The lack of randomized controlled trials has limited the ability to establish an evidence-based treatment algorithm.
Advances in cross-sectional imaging, surgical technique and adjuvant treatment have largely contributed to ameliorate the prognosis, lessen the morbidity and mortality of patients with skull base tumours and to the growing medical investment in the management of these patients. Because clinical assessment of the skull base is limited, cross-sectional imaging became indispensable in the diagnosis, treatment planning and follow-up of patients with suspected skull base pathology and the radiologist is increasingly responsible for the fate of these patients. This review will focus on the advances in imaging technique; contribution to patient's management and on the imaging features of the most common tumours affecting the anterior skull base. Emphasis is given to a systematic approach to skull base pathology based upon an anatomic division taking into account the major tissue constituents in each skull base compartment. The most relevant information that should be conveyed to surgeons and radiation oncologists involved in patient's management will be discussed.
The skull is anterior to the spinal column and is the bony structure that encases the brain. Its purpose ... the facial muscles. The two regions of the skull are the cranial and facial region. The cranial ...
Tomabechi, M; Sako, K; Daita, G; Yonemasu, Y
The case of an intraosseous lipoma involving the left frontal bone is reported. Lipomas of the bone are rare; only three cases of lipomas involving the skull have previously been reported. The differential diagnosis includes a healing bone infarction or fracture, meningioma, hemangioma, and fibrous dysplasia. Diagnosis prior to surgery is difficult.
Aciduman, Ahmet; Arda, Berna; Kahya, Esin; Belen, Deniz
Haly Abbas was one of the pioneering physicians and surgeons of the Eastern world in the 10th century who influenced the Western world by his monumental work, The Royal Book. The book was first partly translated into Latin by Constantinus Africanus in the 11th century without citing the author's name. Haly Abbas was recognized in Europe after full translation of The Royal Book by Stephen of Antioch in 1127. The Royal Book has been accepted as an early source of jerrah-names (surgical books) in the Eastern world. The chapters regarding cranial fractures in Haly Abbas' work include unique management strategies for his period with essential quotations from Paul of Aegina's work Epitome. Both authors preferred free bone flap craniotomy in cranial fractures. Although Paul of Aegina, a Byzantine physician and surgeon, was a connection between ancient traditions and Islamic interpretation, Haly Abbas seemed to play a bridging role between the Roman-Byzantine and the School of Salerno in Europe.
Patel, Chirag R; Fernandez-Miranda, Juan C; Wang, Wei-Hsin; Wang, Eric W
The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources. The anterior skull base extends to the frontal sinus and is important to understand for sinus surgery and sinonasal malignancies. The clivus protects the brainstem and posterior cranial fossa. A thorough appreciation of the anatomy of these various areas allows for endoscopic endonasal approaches to the skull base.
A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open ... falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the ...
Tuna, Elif Bahar; Dündar, Aysun; Çankaya, Abdülkadir Burak; Gençay, Koray
Condylar fractures in children are especially important because of the risk of a mandibular growth-center being affected in the condylar head, which can lead to growth retardation and facial asymmetry. The purpose of this article is to follow up the two and half year clinical and radiological evaluation of the conservative treatment of a 10 year-old patient, who had a unilateral green-stick type fracture. The patient presented with painful facial swelling localized over the left condylar region, limited mouth-opening and mandibular deviation to the left. Panoramic radiography and computed tomography confirmed the diagnosis of incomplete fracture on the left condyle with one side of the bone fractured and the other bent. Closed reduction was chosen to allow for initial fibrous union of the fracture segments and remodeling with a normal functional stimulus. A non-rigid mandibular splint was applied in order to remove the direct pressure on the fracture side of the mandible. Clinical and radiologic examination after 30 months revealed uneventful healing with reduction of the condylar head and remodeling of the condylar process following conservative treatment. PMID:22276078
In skull base tumors associated with a low radiosensitivity for conventional radiotherapy (RT), irradiation with proton or carbon ion beams facilitates a safe and accurate application of high tumor doses due to the favorable beam localization properties of these particle beams. Cranial nerves, the brain stem and normal brain tissue can at the same time be optimally spared.
Issing, Peter R.; Hemmanouil, Ilias; Stöver, Timo; Kempf, Hans-Georg; Wilkens, L.; Heermann, R.; Lenarz, Thomas
Adenoid cystic carcinoma (ACC) is a slowly growing tumor with a particular tendency to infiltrate the surrounding tissue by perineural spread. The clinical diagnosis may prove difficult due to the submucons extension of the tumor, especially at the skull base. This article outlines the clinical characteristics, diagnostics, and treatment modalities in a series of 56 patients with an ACC in the head and neck diagnosed between 1970 and 1998 in 32 females and 24 males. The youngest patient was aged 24 years, the oldest 77 years. The average age was 54 years. In 16 patients the tumor originated in the paranasal sinuses or the nasopharynx and involved the skull base. As a rule, several months passed between the manifestation of the first symptoms such as pain, blocked nose, epistaxis, or diplopia and the initial clinical diagnosis. All patients received surgical treatment, however, complete microscopical resection could only be achieved in approximately one third of the cases. Therefore, nine patients were postoperatively treated with radiotherapy. The average survival rates of the patients with an ACC of the skull base were only 99 months as compared to 144 months in the patients without skull base involvement. ImagesFigure 1 PMID:17171116
Falland-Cheung, Lisa; Waddell, J Neil; Chun Li, Kai; Tong, Darryl; Brunton, Paul
Conducting in vitro research for forensic, impact and injury simulation modelling generally involves the use of a skull simulant with mechanical properties similar to those found in the human skull. For this study epoxy resin, fibre filled epoxy resin, 3D-printing filaments (PETG, PLA) and self-cure acrylic denture base resin were used to fabricate the specimens (n=20 per material group), according to ISO 527-2 IBB and ISO20795-1. Tensile and flexural testing in a universal testing machine was used to measure their tensile/flexural elastic modulus and strength. The results showed that the epoxy resin and fibre filled epoxy resin had similar tensile elastic moduli (no statistical significant difference) with lower values observed for the other materials. The fibre filled epoxy resin had a considerably higher flexural elastic modulus and strength, possibly attributed to the presence of fibres. Of the simulants tested, epoxy resin had an elastic modulus and flexural strength close to that of mean human skull values reported in the literature, and thus can be considered as a suitable skull simulant for a skin/skull/brain model for lower impact forces that do not exceed the fracture stress. For higher impact forces a 3D printing filament (PLA) may be a more suitable skull simulant material, due to its closer match to fracture stresses found in human skull bone. Influencing factors were also anisotropy, heterogeneity and viscoelasticity of human skull bone and simulant specimens.
Bullitt, E; Lehman, R A
This retrospective study includes 18 patients who underwent 28 admissions for treatment of osteomyelitis of the skull. Each admission was reviewed separately. Systemic symptoms were rare and signalled the presence of an associated collection of pus. Films of the skull, polytomography and bone scans were all useful in establishing the diagnosis, whereas white blood cell count, erythrocyte sedimentation rate and brain scans were of little value. Complete surgical debridement was found to be of significantly greater value than limited surgical debridement. The surgical results appeared to be improved when surgery was followed by long courses of antibiotics. Each patient who received complete surgical debridement followed by at least six weeks of antibiotic therapy was cured.
Sulaiman, Nur Amirah; Osman, Khairul; Hamzah, Noor Hazfalinda; Amir, Sri Pawita Albakri
Deaths due to blunt force trauma to the head as a result of assault are some of the most common cases encountered by the practicing forensic pathologist. Previous studies have shown inflicting injury to the head region is one of the most effective methods of murder. The important factors that determine severity of trauma include the type of weapon used, type and site of skull fracture, intracranial haemorrhage and severity of brain injury. The aim of this study was to determine the characteristics of blunt force trauma to the skull produced by different instruments. Nine adult monkeys (Macaca fascicularis) skulls were used as models. Commonly found blunt objects comprising of Warrington hammer, hockey stick and open face helmet were used in this study. A machine calibrated force generator was used to hold the blunt object in place and to hit the skulls at forces of 12.5N and 25N. Resultant traumatic effects and fractures (linear, depressed, basilar, comminuted, and distastic) were analyzed according to type of blunt object used; surface area of contact and absolute force (N/cm(2)) delivered. Results showed that all investigated instruments were capable of producing similar injuries. The severity of trauma was not related to the surface area of contact with the blunt objects. However, only high absolute forces produced comminuted fractures. These findings were observational, as the samples were too small for statistical conclusions.
Nyström, B; Allard, H; Karlsson, H
During transportation of patients under skull traction, swinging of the weights produces acceleration forces that not only can cause pain and discomfort for the patient, but also can cause worsening of the cervical fracture or dislocation. Skull traction systems also involve friction forces. In a system with one pulley, the friction forces were 10 to 21.5% of the weight applied but, in a system with three pulleys (Stryker SurgiBed 965), they were as much as 65%. A new spring traction device that permits traction during transportation showed better physical characteristics than the hanging weight systems.
... results may be due to: Fracture Tumor Breakdown ( erosion ) or calcium loss of the bone Movement of ... Absence seizure Alzheimer disease Dementia Ear infection - chronic Erosion Friedreich ataxia Hydrocephalus Increased intracranial pressure Malocclusion of ...
Hoffmann, Almut; Wegner, Dietrich
Since the end of World War II two of the most important anthropological artefacts of the Museum für Vor- und Frühgeschichte in Berlin, the skulls and skeletons of Le Moustier and Combe Capelle, were believed to be missing or destroyed, respectively. The postcrania were severely damaged during a fire after the museum was bombed in February 1945, while the skulls were brought to the Soviet Union in 1945. In 1965, the skull of the Neanderthal man from Le Moustier and the chain of the grave of Combe Capelle were found amongst the art objects returned by the Soviet Union into the German Democratic Republic in 1958. However, the Combe Capelle skull was still missing. In the end of 2001 this skull could be found and identified in a store-house of the museum. Now, one the oldest known representatives of Homo sapiens sapiens is again available for scientific research and public exhibitions.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Skull punch. 882.4750 Section 882.4750 Food and... NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4750 Skull punch. (a) Identification. A skull punch is a device used to punch holes through a patient's skull to allow fixation of cranioplasty plates...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Skull punch. 882.4750 Section 882.4750 Food and... NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4750 Skull punch. (a) Identification. A skull punch is a device used to punch holes through a patient's skull to allow fixation of cranioplasty plates...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Skull punch. 882.4750 Section 882.4750 Food and... NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4750 Skull punch. (a) Identification. A skull punch is a device used to punch holes through a patient's skull to allow fixation of cranioplasty plates...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Skull punch. 882.4750 Section 882.4750 Food and... NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4750 Skull punch. (a) Identification. A skull punch is a device used to punch holes through a patient's skull to allow fixation of cranioplasty plates...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Skull punch. 882.4750 Section 882.4750 Food and... NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4750 Skull punch. (a) Identification. A skull punch is a device used to punch holes through a patient's skull to allow fixation of cranioplasty plates...
Lichens growing on skulls were known in late medieval times as usnea or moss of a dead man's skull and were recommended as highly beneficial in various diseases. They were, in addition, the main ingredient of Unguentum armariun, a liniment used in a curious medical practice: the magnetic cure of wounds. We can place this chapter of the history of phytotherapy within the wider cultural context of the period, which saw the definition of nature become increasingly more fluid and open to a variety of novel interpretations.
Gresham, Malia S.; Shen, Steven; Zhang, Yi J.; Gallagher, Kelly
Oncogenic osteomalacia (OO) is an uncommon but treatable cause of osteomalacia related to tumor production of FGF23, usually caused by benign mesenchymal neoplasms. Paranasal sinus glomangiomas are a rare cause of OO, with only one previously reported case. Here we describe a second case (first reported in English) of paranasal sinus glomangioma-induced osteomalacia in a 42-year-old man. He presented with weakness and multiple spontaneous fractures, and was found to have an ethmoid sinus glomangioma with intracranial extension. The tumor was removed via endoscopic endonasal approach to the anterior skull base, which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively. PMID:28180054
Lillie, Elizabeth M; Urban, Jillian E; Lynch, Sarah K; Weaver, Ashley A; Stitzel, Joel D
Head injuries resulting from motor vehicle crashes (MVC) are extremely common, yet the details of the mechanism of injury remain to be well characterized. Skull deformation is believed to be a contributing factor to some types of traumatic brain injury (TBI). Understanding biomechanical contributors to skull deformation would provide further insight into the mechanism of head injury resulting from blunt trauma. In particular, skull thickness is thought be a very important factor governing deformation of the skull and its propensity for fracture. Previously, age- and sex-based skull cortical thickness changes were difficult to evaluate based on the need for cadaveric skulls. In this cross-sectional study, skull thickness changes with age and sex have been evaluated at homologous locations using a validated cortical density-based algorithm to accurately quantify cortical thickness from 123 high-resolution clinical computed tomography (CT) scans. The flat bones of the skull have a sandwich structure; therefore, skull thickness was evaluated for the inner and outer tables as well the full thickness. General trends indicated an increase in the full skull thickness, mostly attributed to an increase in the thickness of the diploic layer; however, these trends were not found to be statistically significant. There was a significant relationship between cortical thinning and age for both tables of the frontal, occipital, and parietal bones ranging between a 36% and 60% decrease from ages 20 to 100 years in females, whereas males exhibited no significant changes. Understanding how cortical and full skull thickness changes with age from a wide range of subjects can have implications in improving the biofidelity of age- and sex-specific finite element models and therefore aid in the prediction and understanding of TBI from impact and blast injuries.
Raymond, David E; Bir, Cynthia A
The field of forensic injury biomechanics is an emerging field. Biomechanically validated tools may assist interdisciplinary teams of investigators in assessing mechanisms of blunt head trauma resulting in skull fractures. The objective of this study is to assess the biofidelity of spherical, frangible skull-brain (SB) surrogates. Blunt impacts were conducted at 20 m/s, using an instrumented 103 g rigid impactor, to the temporo-parietal region of four defleshed cephalic postmortem human subjects (PMHS). Force-deformation response, fracture tolerance, and fracture patterns were recorded for comparison to spherical skull-brain surrogates. Three brain substitutes were assessed: 10% gelatin, lead shot with Styrofoam and water. Force-deformation response of the skull-brain surrogates was similar to defleshed PMHS up to the point of fracture; however, none of the surrogates fractured at tolerance levels comparable to the PMHS. Fracture patterns of the skull-brain surrogates were linear and radiating, while PMHS fractures were all depressed, comminuted.
Kelly, Hillary R; Curtin, Hugh D
Skull base imaging requires a thorough knowledge of the complex anatomy of this region, including the numerous fissures and foramina and the major neurovascular structures that traverse them. Computed tomography (CT) and magnetic resonance imaging (MRI) play complementary roles in imaging of the skull base. MR is the preferred modality for evaluation of the soft tissues, the cranial nerves, and the medullary spaces of bone, while CT is preferred for demonstrating thin cortical bone structure. The anatomic location and origin of a lesion as well as the specific CT and MR findings can often narrow the differential diagnosis to a short list of possibilities. However, the primary role of the imaging specialist in evaluating the skull base is usually to define the extent of the lesion and determine its relationship to vital neurovascular structures. Technologic advances in imaging and radiation therapy, as well as surgical technique, have allowed for more aggressive approaches and improved outcomes, further emphasizing the importance of precise preoperative mapping of skull base lesions via imaging. Tumors arising from and affecting the cranial nerves at the skull base are considered here.
Tsermoulas, Georgios; Aidonis, Asterios; Flint, Graham
Cranial trepanation is the oldest neurosurgical operation and its roots date back to prehistory. For many centuries, religion and mysticism were strongly linked to the cause of diseases, and trepanation was associated with superstitions such as releasing evil spirits from inside the skull. The Hippocratic treatise "On injuries of the head" was therefore a revolutionary work, as it presented a systematic approach to the management of cranial trauma, one that was devoid of spiritual elements. Unfortunately, there are only a limited number of skeletal findings that confirm that the practice of trepanation was performed as part of Hippocratic medicine. In this historical vignette, the authors present a trepanned skull that was found in Chios, Greece, as evidence of the procedure having been performed in accordance with the Hippocratic teaching. The skull bears a parietal bur hole in association with a linear fracture, and it is clear that the patient survived the procedure. In this analysis, the authors examine the application of the original Hippocratic teaching to the skull of Chios. The rationalization of trepanation was clearly a significant achievement in the evolution of neurosurgery.
The skull base surgery is one of the most demanding surgeries. There are different structures that can be injured easily, by operating in the skull base. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Due to the pioneering work of Cushing, Hirsch, Yasargil, Krause, Dandy and other dedicated neurosurgeons, it is possible to address the tumor and other lesions in the anterior, the mid-line and the posterior cranial base. With the transsphenoidal, the frontolateral, the pterional and the lateral suboccipital approach nearly every region of the skull base is exposable. In the current state many different skull base approaches are described for various neurosurgical diseases during the last 20 years. The selection of an approach may differ from country to country, e.g., in the United States orbitozygomaticotomy for special lesions of the anterior skull base or petrosectomy for clivus meningiomas, are found more frequently than in Europe. The reason for writing the review was the question: Are there keyhole approaches with which someone can deal with a vast variety of lesions in the neurosurgical field? In my opinion the different surgical approaches mentioned above cover almost 95% of all skull base tumors and lesions. In the following text these approaches will be described. These approaches are: 1) pterional approach 2) frontolateral approach 3) transsphenoidal approach 4) suboccipital lateral approach These approaches can be extended and combined with each other. In the following we want to enhance this philosophy. PMID:20602753
Lustrin, E S; Robertson, R L; Tilak, S
CT and MR imaging increasingly are being used for the evaluation of the skull base. New innovative techniques have revolutionized radiologic understanding of normal skull base anatomy. Thus, normal anatomic relationships with radiographic correlation are vital for accurate pathologic assessment.
It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text. PMID:27429940
Job, Joici; Branstetter, Barton F
The posterior skull base can be involved by a variety of pathologic processes. They can be broadly classified as: traumatic, neoplastic, vascular, and inflammatory. Pathology in the posterior skull base usually involves the lower cranial nerves, either as a source of pathology or a secondary source of symptoms. This review will categorize pathology arising in the posterior skull base and describe how it affects the skull base itself and surrounding structures.
Torimitsu, Suguru; Nishida, Yoshifumi; Takano, Tachio; Koizumi, Yoshinori; Hayakawa, Mutsumi; Yajima, Daisuke; Inokuchi, Go; Makino, Yohsuke; Motomura, Ayumi; Chiba, Fumiko; Iwase, Hirotaro
The aim of this study was to determine if biomechanical investigations of skull samples are reliable after skulls have been subjected to a freezing and thawing process. The skulls were obtained from 105 Japanese cadavers (66 males, 39 females) of known age that were autopsied in our department between October 2012 and June 2013. We obtained bone specimens from eight sites (four bilaterally symmetrical pairs) of each skull and measured the mass of each specimen. They were then classified into three groups (A, B, C) based on the duration of freezing of the experimental samples. The left-side samples were subjected to frozen storage (experimental group). The corresponding right-side samples were their controls. Bending tests were performed on the controls immediately after they were obtained. The experimental samples were preserved by refrigeration at -20 °C for 1 day (group A), 1 month (group B), or 3 months (group C). Following refrigeration, these samples were placed at 37 °C to thaw for 1 h and then were subjected to bending tests using a three-point-bending apparatus attached to a Handy force gauge. The device recorded the fracture load automatically when the specimen fractured. Statistical analyses revealed that there were no significant differences in sample fracture loads between the frozen preserved/thawed samples and the unfrozen controls for each of the cryopreservation intervals. We eliminated any possible sample mass bias by using controls from the same skull in each case. The results suggest that the freezing/thawing process has little effect on the mechanical properties of human skulls. Thus, frozen storage for up to 3 months is a good method for preserving human skulls.
MORRISS-KAY, GILLIAN M.
This review describes the evolutionary history of the mammalian skull vault as a basis for understanding its complex structure. Current information on the developmental tissue origins of the skull vault bones (mesoderm and neural crest) is assessed for mammals and other tetrapods. This information is discussed in the context of evolutionary changes in the proportions of the skull vault bones at the sarcopterygian-tetrapod transition. The dual tissue origin of the skull vault is considered in relation to the molecular mechanisms underlying osteogenic cell proliferation and differentiation in the sutural growth centres and in the proportionate contributions of different sutures to skull growth. PMID:11523816
Reconstruction materials and techniques for the base of the skull have undergone rapid developments and differentiation in recent years. While mostly autotransplants, collagens or resorbable alloplastic materials are preferred for duraplasties, pronounced organ-specific differences can be observed in the reconstruction of hard tissues. The use of polymethylmethacryl bone cement, once wide-spread, has decreased greatly due to the release of toxic monomers. Bony autotransplants are still used primarily for smaller skull-base defects, intraoperatively formable titanium nets may be also used for larger fronto- or laterobasal reconstructions of bony defects. Defects in visible areas are increasingly closed with preformed titanium or ceramic implants, which are planned and fitted to the individual patient using preoperative CT imaging. At the skull base, this applies especially to reconstructions of the frontal sinus. For extensive reconstructions of the orbita, titanium nets and non-resorbable plastics have proven valuable; in closing smaller defects especially of the orbital floor, resorbable implants based on Polyglactin 901 are also used. PMID:22073100
Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark
Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines.
The essay explores the hypothesis of colonial collecting processes involving the active addition of the colonial context and historical past to museum objects through the production of short stories. It examines the emergent historicity of collections through a focus on the "histories" that museum workers and colonial agents have been attaching to scientific collections of human skulls. Drawing on the notions of collection trajectory and historiographical work, it offers an alternative perspective from which to approach the creation of singular histories and individual archives for objects in collections.
With the advances of cross-sectional imaging radiologists gained an increasing responsibility in the management of patients with skull base pathology. As this anatomic area is hidden to clinical exam, surgeons and radiation oncologists have to rely on imaging studies to plan the most adequate treatment. To fulfil these endeavour radiologists need to be knowledgeable about skull base anatomy, about the main treatment options available, their indications and contra-indications and needs to be aware of the wide gamut of pathologies seen in this anatomic region. This article will provide a radiologists' friendly approach to the central skull base and will review the most common central skull base tumours and tumours intrinsic to the bony skull base.
Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...
Lillie, Elizabeth M; Urban, Jillian E; Weaver, Ashley A; Powers, Alexander K; Stitzel, Joel D
Brain injuries resulting from motor vehicle crashes (MVC) are extremely common yet the details of the mechanism of injury remain to be well characterized. Skull deformation is believed to be a contributing factor to some types of traumatic brain injury (TBI). Understanding biomechanical contributors to skull deformation would provide further insight into the mechanism of head injury resulting from blunt trauma. In particular, skull thickness is thought be a very important factor governing deformation of the skull and its propensity for fracture. Current computed tomography (CT) technology is limited in its ability to accurately measure cortical thickness using standard techniques. A method to evaluate cortical thickness using cortical density measured from CT data has been developed previously. This effort validates this technique for measurement of skull table thickness in clinical head CT scans using two postmortem human specimens. Bone samples were harvested from the skulls of two cadavers and scanned with microCT to evaluate the accuracy of the estimated cortical thickness measured from clinical CT. Clinical scans were collected at 0.488 and 0.625 mm in plane resolution with 0.625 mm thickness. The overall cortical thickness error was determined to be 0.078 ± 0.58 mm for cortical samples thinner than 4 mm. It was determined that 91.3% of these differences fell within the scanner resolution. Color maps of clinical CT thickness estimations are comparable to color maps of microCT thickness measurements, indicating good quantitative agreement. These data confirm that the cortical density algorithm successfully estimates skull table thickness from clinical CT scans. The application of this technique to clinical CT scans enables evaluation of cortical thickness in population-based studies.
Lillie, Elizabeth M; Urban, Jillian E; Weaver, Ashley A; Powers, Alexander K; Stitzel, Joel D
Brain injuries resulting from motor vehicle crashes (MVC) are extremely common yet the details of the mechanism of injury remain to be well characterized. Skull deformation is believed to be a contributing factor to some types of traumatic brain injury (TBI). Understanding biomechanical contributors to skull deformation would provide further insight into the mechanism of head injury resulting from blunt trauma. In particular, skull thickness is thought be a very important factor governing deformation of the skull and its propensity for fracture. Current computed tomography (CT) technology is limited in its ability to accurately measure cortical thickness using standard techniques. A method to evaluate cortical thickness using cortical density measured from CT data has been developed previously. This effort validates this technique for measurement of skull table thickness in clinical head CT scans using two postmortem human specimens. Bone samples were harvested from the skulls of two cadavers and scanned with microCT to evaluate the accuracy of the estimated cortical thickness measured from clinical CT. Clinical scans were collected at 0.488 and 0.625 mm in plane resolution with 0.625 mm thickness. The overall cortical thickness error was determined to be 0.078 ± 0.58 mm for cortical samples thinner than 4 mm. It was determined that 91.3% of these differences fell within the scanner resolution. Color maps of clinical CT thickness estimations are comparable to color maps of microCT thickness measurements, indicating good quantitative agreement. These data confirm that the cortical density algorithm successfully estimates skull table thickness from clinical CT scans. The application of this technique to clinical CT scans enables evaluation of cortical thickness in population-based studies. PMID:25441171
Bhullar, Bhart-Anjan S; Marugán-Lobón, Jesús; Racimo, Fernando; Bever, Gabe S; Rowe, Timothy B; Norell, Mark A; Abzhanov, Arhat
The interplay of evolution and development has been at the heart of evolutionary theory for more than a century. Heterochrony—change in the timing or rate of developmental events—has been implicated in the evolution of major vertebrate lineages such as mammals, including humans. Birds are the most speciose land vertebrates, with more than 10,000 living species representing a bewildering array of ecologies. Their anatomy is radically different from that of other vertebrates. The unique bird skull houses two highly specialized systems: the sophisticated visual and neuromuscular coordination system allows flight coordination and exploitation of diverse visual landscapes, and the astonishing variations of the beak enable a wide range of avian lifestyles. Here we use a geometric morphometric approach integrating developmental, neontological and palaeontological data to show that the heterochronic process of paedomorphosis, by which descendants resemble the juveniles of their ancestors, is responsible for several major evolutionary transitions in the origin of birds. We analysed the variability of a series of landmarks on all known theropod dinosaur skull ontogenies as well as outgroups and birds. The first dimension of variability captured ontogeny, indicating a conserved ontogenetic trajectory. The second dimension accounted for phylogenetic change towards more bird-like dinosaurs. Basally branching eumaniraptorans and avialans clustered with embryos of other archosaurs, indicating paedomorphosis. Our results reveal at least four paedomorphic episodes in the history of birds combined with localized peramorphosis (development beyond the adult state of ancestors) in the beak. Paedomorphic enlargement of the eyes and associated brain regions parallels the enlargement of the nasal cavity and olfactory brain in mammals. This study can be a model for investigations of heterochrony in evolutionary transitions, illuminating the origin of adaptive features and inspiring
Petrone, Pierpaolo; Niola, Massimo; Di Lorenzo, Pierpaolo; Paternoster, Mariano; Graziano, Vincenzo; Quaremba, Giuseppe; Buccelli, Claudio
Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP). Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death. PMID:26018014
Petrone, Pierpaolo; Niola, Massimo; Di Lorenzo, Pierpaolo; Paternoster, Mariano; Graziano, Vincenzo; Quaremba, Giuseppe; Buccelli, Claudio
Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP). Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.
Estrada, Héctor; Rebling, Johannes; Turner, Jake; Razansky, Daniel
It has been well recognized that the presence of a skull imposes harsh restrictions on the use of ultrasound and optoacoustic techniques in the study, treatment and modulation of the brain function. We propose a rigorous modeling and experimental methodology for estimating the insertion loss and the elastic constants of the skull over a wide range of frequencies and incidence angles. A point-source-like excitation of ultrawideband acoustic radiation was induced via the absorption of nanosecond duration laser pulses by a 20 μm diameter microsphere. The acoustic waves transmitted through the skull are recorded by a broadband, spherically focused ultrasound transducer. A coregistered pulse-echo ultrasound scan is subsequently performed to provide accurate skull geometry to be fed into an acoustic transmission model represented in an angular spectrum domain. The modeling predictions were validated by measurements taken from a glass cover-slip and ex vivo adult mouse skulls. The flexible semi-analytical formulation of the model allows for seamless extension to other transducer geometries and diverse experimental scenarios involving broadband acoustic transmission through locally flat solid structures. It is anticipated that accurate quantification and modeling of the skull transmission effects would ultimately allow for skull aberration correction in a broad variety of applications employing transcranial detection or transmission of high frequency ultrasound.
Estrada, Héctor; Rebling, Johannes; Turner, Jake; Razansky, Daniel
It has been well recognized that the presence of a skull imposes harsh restrictions on the use of ultrasound and optoacoustic techniques in the study, treatment and modulation of the brain function. We propose a rigorous modeling and experimental methodology for estimating the insertion loss and the elastic constants of the skull over a wide range of frequencies and incidence angles. A point-source-like excitation of ultrawideband acoustic radiation was induced via the absorption of nanosecond duration laser pulses by a 20 μm diameter microsphere. The acoustic waves transmitted through the skull are recorded by a broadband, spherically focused ultrasound transducer. A coregistered pulse-echo ultrasound scan is subsequently performed to provide accurate skull geometry to be fed into an acoustic transmission model represented in an angular spectrum domain. The modeling predictions were validated by measurements taken from a glass cover-slip and ex vivo adult mouse skulls. The flexible semi-analytical formulation of the model allows for seamless extension to other transducer geometries and diverse experimental scenarios involving broadband acoustic transmission through locally flat solid structures. It is anticipated that accurate quantification and modeling of the skull transmission effects would ultimately allow for skull aberration correction in a broad variety of applications employing transcranial detection or transmission of high frequency ultrasound.
Walcott, Brian P; Nahed, Brian V; Kahle, Kristopher T; Sekhar, Laligam N; Ferreira, Manuel J
Fractures of the anterior skull base can lead to pseudoaneurysm formation as a result of direct injury to a vessel wall. Pseudoaneurysms in this location are challenging to treat, as both perforator and distal blood supply must be maintained. Additionally, traumatic skull base fractures can lead to a rare condition of cerebral blood vessel herniation through the bony defect, further complicating treatment planning. Treatment of these lesions is essential to (1) prevent the occurrence of potentially fatal subarachnoid hemorrhage and (2) prevent dissection from propagating and compromising blood flow to distal vessels, perforators, and even parent vessels. We present a unique case of a traumatic proximal anterior cerebral artery pseudoaneurysm, herniating through a skull base defect. Treatment consisted of aneurysm trapping and bypass with skull base reconstruction.
Yang, Yi; Guan, Jian; Ma, Wenbin; Li, Yongning; Xing, Bing; Ren, Zuyuan; Su, Changbao; Wang, Renzhi
Abstract Primary intraosseous cavernous hemangiomas (PICHs) are benign vascular tumors that may involve any part of the body. PICH occurs more frequently in the spine and less commonly in skull. The earliest description in the English literature was in 1845 by Toynbee, who reported a vascular tumor arising in the confines of the parietal bone. Skull PICHs do not always have typical radiologic features and should always be considered in the differential diagnosis of malignant skull lesions. We now reviewed and analyzed related literatures in detail with reporting a rare case of PICH in the left front bone that was surgically resected. PMID:26986133
Iten, P X
A method of matching skulls with photographic portraits or impressions of the face in clay by video superimposition is described. Two different practical cases are presented. The first one deals with the identification of a skull of a six-year-old girl, the second with the identification of the skull of the famous Swiss Pedagogue Johann Heinrich Pestalozzi, who died about 160 years ago. The advantages and versatility of this method are shown; also the setup of the equipment and the working technique.
Mittra, Erik S; Iagaru, Andrei; Quon, Andrew; Fischbein, Nancy
The utility of 18-F-fluorodeoxyglucose-positron emission tomography (PET) and PET/CT for the evaluation of skull base tumors is incompletely investigated, as a limited number of studies specifically focus on this region with regard to PET imaging. Several patterns can be ascertained, however, by synthesizing the data from various published reports and cases of primary skull base malignancies, as well as head and neck malignancies that extend secondarily to the skull base, including nasopharyngeal carcinoma, nasal cavity and paranasal sinus tumors, parotid cancers, and orbital tumors.
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Skull plate anvil. 882.4030 Section 882.4030 Food... DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4030 Skull plate anvil. (a) Identification. A skull plate anvil is a device used to form alterable skull plates in the proper shape to...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures....
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Skull plate anvil. 882.4030 Section 882.4030 Food... DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4030 Skull plate anvil. (a) Identification. A skull plate anvil is a device used to form alterable skull plates in the proper shape to...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures....
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Skull plate anvil. 882.4030 Section 882.4030 Food... DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4030 Skull plate anvil. (a) Identification. A skull plate anvil is a device used to form alterable skull plates in the proper shape to...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures....
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Skull plate anvil. 882.4030 Section 882.4030 Food... DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4030 Skull plate anvil. (a) Identification. A skull plate anvil is a device used to form alterable skull plates in the proper shape to...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures....
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurosurgical head holder (skull clamp). 882.4460... holder (skull clamp). (a) Identification. A neurosurgical head holder (skull clamp) is a device used to clamp the patient's skull to hold head and neck in a particular position during surgical procedures....
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Skull plate anvil. 882.4030 Section 882.4030 Food... DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4030 Skull plate anvil. (a) Identification. A skull plate anvil is a device used to form alterable skull plates in the proper shape to...
Ruiz-Monachesi, Mario R; Lavilla, Esteban O; Montero, Ricardo
The hylid genus Phyllomedusa comprises charismatic frogs commonly known as monkey, leaf or green frogs, and is the most diverse genus of the subfamily Phyllomedusinae, including about 31 species. Although there is some information about the anatomy of these frogs, little is known about the osteology. Here the adult skull of Phyllomedusa sauvagii, both articulated and disarticulated, is described and the intraspecific variation is reported. Additionally, cartilage associated with the adult skull, such as the nasal capsules, auditory apparatus, and hyobranchial apparatus, are included in the analysis. Further examination of disarticulated bones reveals their remarkable complexity, specifically in the sphenethmoid and of the oocipital region. The description of disarticulated bones is useful for the identification of fossil remains as well as providing morphological characteristics that are phylogenetically informative. When comparing the skull morphology with the available information of other species of the genus, Phyllomesusa sauvagii skull resembles more that of P. vaillantii and P. venusta than P. atelopoides.
Laird, Myra F; Schroeder, Lauren; Garvin, Heather M; Scott, Jill E; Dembo, Mana; Radovčić, Davorka; Musiba, Charles M; Ackermann, Rebecca R; Schmid, Peter; Hawks, John; Berger, Lee R; de Ruiter, Darryl J
The species Homo naledi was recently named from specimens recovered from the Dinaledi Chamber of the Rising Star cave system in South Africa. This large skeletal sample lacks associated faunal material and currently does not have a known chronological context. In this paper, we present comprehensive descriptions and metric comparisons of the recovered cranial and mandibular material. We describe 41 elements attributed to Dinaledi Hominin (DH1-DH5) individuals and paratype U.W. 101-377, and 32 additional cranial fragments. The H. naledi material was compared to Plio-Pleistocene fossil hominins using qualitative and quantitative analyses including over 100 linear measurements and ratios. We find that the Dinaledi cranial sample represents an anatomically homogeneous population that expands the range of morphological variation attributable to the genus Homo. Despite a relatively small cranial capacity that is within the range of australopiths and a few specimens of early Homo, H. naledi shares cranial characters with species across the genus Homo, including Homo habilis, Homo rudolfensis, Homo erectus, and Middle Pleistocene Homo. These include aspects of cranial form, facial morphology, and mandibular anatomy. However, the skull of H. naledi is readily distinguishable from existing species of Homo in both qualitative and quantitative assessments. Since H. naledi is currently undated, we discuss the evolutionary implications of its cranial morphology in a range of chronological frameworks. Finally, we designate a sixth Dinaledi Hominin (DH6) individual based on a juvenile mandible.
Averianov, Alexander; Obraztsova, Ekaterina; Danilov, Igor; Skutschas, Pavel; Jin, Jianhua
Maofelis cantonensis gen. and sp. nov. is described based on a complete cranium from the middle-upper Eocene Youganwo Formation of Maoming Basin, Guangdong Province, China. The new taxon has characters diagnostic for Nimravidae such as a short cat-like skull, short palate, ventral surface of petrosal dorsal to that of basioccipital, serrations on the distal carina of canine, reduced anterior premolars, and absence of posterior molars (M2-3). It is plesiomorphic nimravid taxon similar to Nimravidae indet. from Quercy (France) in having the glenoid pedicle and mastoid process without ventral projections, a planar basicranium in which the lateral rim is not ventrally buttressed, and P1 present. The upper canine is less flattened than in other Nimravidae. Maofelis cantonensis gen. and sp. nov. exemplifies the earliest stage of development of sabertooth specialization characteristic of Nimravidae. This taxon, together with other middle-late Eocene nimravid records in South Asia, suggests origin and initial diversification of Nimravidae in Asia. We propose that this group dispersed to North America in the late Eocene and to Europe in the early Oligocene. The subsequent Oligocene diversification of Nimravidae took place in North America and Europe, while in Asia this group declined in the Oligocene, likely because of the earlier development of open habitats on that continent. PMID:27161785
Kothari, Kamlesh; Singh, Amit Kumar; Das, Shishir
In this study we are describing an unusual case of the boundary fence (6 inch long) penetrating through the skull vault and lodging into the middle cranial fossa. A 10 years old male child fell onto his house fence while playing on the terrace. The metal fence penetrated through the scalp, parietal bone, midbrain and the midface, fracturing the parietal and the midfacial bones. CT-scans were obtained to view the trajectory and the position of the fence. The amount of midbrain injury was also accessed. The degree of morbidity vis-à-vis the type of injury was surprisingly low. Safe access to the fence was made through a bicoronal incision and modified bifrontal craniectomy to retrieve the lodged portion of the fence. These kind of penetrating injuries are rare considering the thickness of the vault. Proper preoperative planning and team approach is required for the safe surgical removal of the objects. PMID:23833500
Narayanan, Vairavan; Narayanan, Prepageran; Rajagopalan, Raman; Karuppiah, Ravindran; Rahman, Zainal Ariff Abdul; Wormald, Peter-John; Van Hasselt, Charles Andrew; Waran, Vicknes
Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.
Baker, S.R.; Gaylord, G.M.; Lantos, G.; Tabaddor, K.; Gallagher, E.J.
A prospective study was performed to determine the effect of restrictive criteria on the use of emergency skull radiography and computed tomography (CT) of the head. Emergency skull radiography required the completion of a special requisition form. Emergency CT of the head was done at the request of senior consultants and was available on a full-time basis. Over 1 year, 2758 skull studies were performed, a decrease of 39.1% when compared with the year before restrictive criteria were instituted, during which 4587 skull examinations were done. In the same period, the number of emergency CT scans of the head increased by 45.7%, from 471 in the control year to 686 in the experimental year. With the use of restrictive criteria, a net savings of $164,000 was achieved. Our results suggest that the use of restrictive criteria is a cost-effective means of limiting skull radiography when CT of the head is readily available.
Curtis, Neil; Jones, Marc E. H.; Shi, Junfen; O'Higgins, Paul; Evans, Susan E.; Fagan, Michael J.
The vertebrate skull evolved to protect the brain and sense organs, but with the appearance of jaws and associated forces there was a remarkable structural diversification. This suggests that the evolution of skull form may be linked to these forces, but an important area of debate is whether bone in the skull is minimised with respect to these forces, or whether skulls are mechanically “over-designed” and constrained by phylogeny and development. Mechanical analysis of diapsid reptile skulls could shed light on this longstanding debate. Compared to those of mammals, the skulls of many extant and extinct diapsids comprise an open framework of fenestrae (window-like openings) separated by bony struts (e.g., lizards, tuatara, dinosaurs and crocodiles), a cranial form thought to be strongly linked to feeding forces. We investigated this link by utilising the powerful engineering approach of multibody dynamics analysis to predict the physiological forces acting on the skull of the diapsid reptile Sphenodon. We then ran a series of structural finite element analyses to assess the correlation between bone strain and skull form. With comprehensive loading we found that the distribution of peak von Mises strains was particularly uniform throughout the skull, although specific regions were dominated by tensile strains while others were dominated by compressive strains. Our analyses suggest that the frame-like skulls of diapsid reptiles are probably optimally formed (mechanically ideal: sufficient strength with the minimal amount of bone) with respect to functional forces; they are efficient in terms of having minimal bone volume, minimal weight, and also minimal energy demands in maintenance. PMID:22216358
An effort has been under way for years to make the ordering of skull films in trauma more medically rational. Because the vast majority of skull films have no significant impact on patient management, effort had centered on increasing the yield by limiting radiographs to those who have one or more ''high-yield criteria.'' The publically promulgated high-yield criteria, however, were insufficiently sensitive to pick up some rare occult injuries. Emphasis recently has shifted to low-yield findings (scalp laceration, scalp hematoma, dizziness, headache, and asymptomatic). Although by common practice the presence of one or more of these low-yield findings often results in a skull film, omitting them appears to be extremely safe provided that the patient has no other clinically suspicious findings. Additionally, skull films are no longer the procedure of choice in patients with a neurosurgical emergency. A patient management strategy reflecting recent research is soon to be released with the FDA Skull Panel's final report.
Sawosz, P.; Wojtkiewicz, S.; Kacprzak, M.; Weigl, W.; Borowska-Solonynko, A.; Krajewski, P.; Bejm, K.; Milej, D.; Ciszek, B.; Maniewski, R.; Liebert, A.
Measurements of optical translucency of human skulls were carried out. An incandescent light source and a CCD camera were used to measure the distribution of light transmitted through the skull in 10 subjects post-mortem. We noticed that intra-individual differences in optical translucency may be up to 100 times but inter-individual translucency differences across the skull reach 105 times. Based on the measurement results, a “theoretical” experiment was simulated. Monte-Carlo calculations were used in order to evaluate the influence of the differences in optical translucency of the skull on results of NIRS measurements. In these calculations a functional stimulation was done, in which the oxyhemoglobin and deoxyhemoglobin concentrations in the brain cortex change by 5μM and −5μM respectively. The maximal discrepancies between assumed hemoglobin concentration changes and hemoglobin concentration changes estimated with Monte-Carlo simulation may reach 50% depending of the translucency of the skull. PMID:28018721
Alessandro, Lucas; Camporro, Julieta Piar; Arakaki, Naomi; Orellana, Nora; Mora, Claudia Andrea
Bone involvement of syphilis can be observed in tertiary and congenital syphilis. It is infrequent during the secondary stage. The skull is the most affected bone in secondary syphilis, and its most frequent form of presentation is proliferative osteitis. If the skull is affected, headache is usual and can be as intense as in meningitis. Osteolyitic lesions may be seen in complimentary imaging studies, with a moth eaten aspect. These lesions raise concern over a number of differential diagnoses, among which are infectious, inflammatory and neoplastic diseases. The definitive diagnosis is made by bone biopsy of the compromised bone. Molecular techniques in the affected tissues increases diagnostic performance. There is no standardized treatment protocol for syphilis since there are no guidelines available. We report a case of a 19 year old female, presenting with a unique osteolytic lesion in the skull due to secondary syphilis.
Lanfer, B; Scherg, M; Dannhauer, M; Knösche, T R; Burger, M; Wolters, C H
The low-conducting human skull is known to have an especially large influence on electroencephalography (EEG) source analysis. Because of difficulties segmenting the complex skull geometry out of magnetic resonance images, volume conductor models for EEG source analysis might contain inaccuracies and simplifications regarding the geometry of the skull. The computer simulation study presented here investigated the influences of a variety of skull geometry deficiencies on EEG forward simulations and source reconstruction from EEG data. Reference EEG data was simulated in a detailed and anatomically plausible reference model. Test models were derived from the reference model representing a variety of skull geometry inaccuracies and simplifications. These included erroneous skull holes, local errors in skull thickness, modeling cavities as bone, downward extension of the model and simplifying the inferior skull or the inferior skull and scalp as layers of constant thickness. The reference EEG data was compared to forward simulations in the test models, and source reconstruction in the test models was performed on the simulated reference data. The finite element method with high-resolution meshes was employed for all forward simulations. It was found that large skull geometry inaccuracies close to the source space, for example, when cutting the model directly below the skull, led to errors of 20mm and more for extended source space regions. Local defects, for example, erroneous skull holes, caused non-negligible errors only in the vicinity of the defect. The study design allowed a comparison of influence size, and guidelines for modeling the skull geometry were concluded.
Idriz, Sanjin; Patel, Jaymin H; Ameli Renani, Seyed; Allan, Rosemary; Vlahos, Ioannis
The use of computed tomography (CT) in clinical practice has been increasing rapidly, with the number of CT examinations performed in adults and children rising by 10% per year in England. Because the radiology community strives to reduce the radiation dose associated with pediatric examinations, external factors, including guidelines for pediatric head injury, are raising expectations for use of cranial CT in the pediatric population. Thus, radiologists are increasingly likely to encounter pediatric head CT examinations in daily practice. The variable appearance of cranial sutures at different ages can be confusing for inexperienced readers of radiologic images. The evolution of multidetector CT with thin-section acquisition increases the clarity of some of these sutures, which may be misinterpreted as fractures. Familiarity with the normal anatomy of the pediatric skull, how it changes with age, and normal variants can assist in translating the increased resolution of multidetector CT into more accurate detection of fractures and confident determination of normality, thereby reducing prolonged hospitalization of children with normal developmental structures that have been misinterpreted as fractures. More important, the potential morbidity and mortality related to false-negative interpretation of fractures as normal sutures may be avoided. The authors describe the normal anatomy of all standard pediatric sutures, common variants, and sutural mimics, thereby providing an accurate and safe framework for CT evaluation of skull trauma in pediatric patients.
Cabrilo, I; Sarrafzadeh, A; Bijlenga, P; Landis, B N; Schaller, K
Neuronavigation is widely considered as a valuable tool during skull base surgery. Advances in neuronavigation technology, with the integration of augmented reality, present advantages over traditional point-based neuronavigation. However, this development has not yet made its way into routine surgical practice, possibly due to a lack of acquaintance with these systems. In this report, we illustrate the usefulness and easy application of augmented reality-based neuronavigation through a case example of a patient with a clivus chordoma. We also demonstrate how augmented reality can help throughout all phases of a skull base procedure, from the verification of neuronavigation accuracy to intraoperative image-guidance.
Shen, Weimin; Cui, Jie; Chen, Jianbin; Weiping, Shen
Patients with Apert syndrome have bilateral coronal craniosynostosis, along with a distinguishing feature of their many deformity, called tower skull. Surgical correction of this deformity is the mainstay of treatment. We describe 3 patients molded top skull after front bone osteotomy orbital bar advancement. This successfully restricted growth of their top skull while allowing growth in other dimensions. Utilization of top-skull molding after cranial surgery shows promise of satisfaction in this setting.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Skull tongs for traction. 882.5960 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5960 Skull tongs for traction. (a) Identification. Skull tongs for traction is an instrument used to immobilize a patient with...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Skull tongs for traction. 882.5960 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5960 Skull tongs for traction. (a) Identification. Skull tongs for traction is an instrument used to immobilize a patient with...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Skull tongs for traction. 882.5960 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5960 Skull tongs for traction. (a) Identification. Skull tongs for traction is an instrument used to immobilize a patient with...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Skull tongs for traction. 882.5960 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5960 Skull tongs for traction. (a) Identification. Skull tongs for traction is an instrument used to immobilize a patient with...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Skull tongs for traction. 882.5960 Section 882...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5960 Skull tongs for traction. (a) Identification. Skull tongs for traction is an instrument used to immobilize a patient with...
Gangadhar, Kiran; Santhosh, Deepa
Skull tumors comprise a wide variety of entities, ranging from chronic inflammatory disease to primary and secondary neoplasms. There is no valid incidence or data about the incidence of skull tumors in general. Primary malignant skull tumors are rare, with most articles reporting single cases. We would discuss some of the frequent tumors in this group and review of the literature for the same.
Kinzl, Hans-Peter; Schreiber, Holger
In biology and medicine there are many problems concrninq in vestigations of the human skeleton Beside the long bones the skull is the most important part of the skeleton for m.surement and iden tifiction The fc:e part9 the brain part and the mandibular part of the skul I are qenetical ly determined sectors with high percritage of individual characteristics
Perry, Avital; Graffeo, Christopher S.; Nesvick, Cody L.; Raghunathan, Aditya; Jentoft, Mark E.; O'Neill, Brian P.; Morris, Padraig P.; Morris, Jonathan M.
Gliosarcoma is an uncommon variant of glioblastoma, which commonly demonstrates dural attachment. However, skull base invasion is rarely seen with this entity. Herein, we report a 44-year-old female patient diagnosed with primary intracranial gliosarcoma extensively invading the skull base and muscles of mastication. She presented to our institution with a three-month history of difficult right jaw opening and retro-orbital pressure and one week of severe right-sided postauricular headache. Head CT demonstrated a 6 cm mass with marked bony erosion. Brain MRI at a one-week interval more clearly characterized tumor extension through the right orbit and muscles of mastication, with overall growth to 7 cm and worsening midline shift. The patient underwent a right frontotemporal craniotomy for gross total resection. Pathology confirmed the diagnosis of gliosarcoma, IDH-wildtype (WHO grade IV). Her postoperative course was uneventful and she was discharged at preoperative neurologic baseline. To our knowledge, this is the third reported case of a primary intracranial gliosarcoma with direct invasion of skull base, brain parenchyma, and extracranial compartment. However, this is the first report case of primary GS invading the surrounding musculature and orbit. This case report highlights the rapid aggressiveness of gliosarcomas and further a prior undescribed radiographic and anatomic finding of skull base invasion with this entity. PMID:28053799
GOTO, Takeo; OHATA, Kenji
With recent advances in surgical technology such as preoperative imaging, neuro-monitoring, and surgical instruments, the surgical resectability of intracranial meningiomas has increased over the last two decades. This study reviewed clinical articles regarding the surgical treatment of meningiomas to clarify the role of surgical excision, with a focus on skull base meningiomas. We sub-classified clinical articles about skull base meningiomas into two categories (anterior and middle fossa meningiomas; and posterior fossa meningiomas) and reviewed papers in each category. In cases with anterior and middle fossa meningiomas, surgical resectability has reached a sufficient level to maximize functional preservation. In cases of posterior fossa meningioma, however, surgical respectability remains insufficient even with full use of recent surgical modalities. Continuous refining of operative procedures is required to obtain more satisfactory outcomes, especially for posterior fossa meningioma. In addition, recent long-term outcomes of stereotactic radiosurgery (SRS) were acceptable for controlling the skull base meningiomas. Therefore, combination with surgical excision and SRS should be considered in complicated skull base meningiomas. PMID:27076382
Lehman, Norman L
Perivascular epithelioid cell tumors (PEComas) are rare, usually benign lesions comprising a family of neoplasms including angiomyolipoma, lymphangioleiomyomatosis, clear cell "sugar" tumors, and clear cell myomelanocytic tumors. This report describes an apparent case of a malignant PEComa of the skull base in a 49-year-old woman, a previously undescribed location for this lesion.
Cule, John; Evans, I. Lynn
The differential diagnosis of the bony lesions known as porotic hyperostosis found on a Bronze Age child's skull is discussed. Keith and Shattock gave an opinion in 1923 that the cause was rickets. A firm conclusion is not reached in this paper, but it is suggested that it was more likely to have been an iron-deficiency anaemia. Images PMID:5717547
Gil-Arnaiz, Irene; Martínez-Trufero, Javier; Pazo-Cid, Roberto Antonio; Felipo, Francesc; Lecumberri, María José; Calderero, Verónica
Gastrointestinal stromal tumours (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. Rectum localisation is infrequent for these neoplasms, accounting for about 5% of all cases. Distant metastases of GIST are also rare. We present a patient with special features: the tumour is localised in rectum and it has an uncommon metastatic site, the skull, implying a complex differential diagnosis approach.
da Cunha, Marcelo Rodrigues; Gushiken, Veronica Ozaki; Mardegan Issa, João Paulo; Iatecola, Amilton; Pettian, Mariane; Santos, Arnaldo Rodrigues
Diabetes mellitus can cause various diseases, including loss of bone mineral density as a characteristic manifestation of osteoporosis. In this condition, bone is more vulnerable to pathologic fractures that can be treated by implantation of biomaterial grafts. The aim of this study was to evaluate the osteogenic capacity of hydroxyapatite implanted into bone defects in the skull of nonobese diabetic mice. Fifteen nonobese diabetic mice were divided into 3 groups: control (nondiabetic), spontaneously diabetic, and spontaneously diabetic receiving insulin replacement applied subcutaneously into the dorsum. Defects were created experimentally in the skull with a surgical bur and filled with hydroxyapatite granules. The animals were killed 4 weeks after surgery, and samples were obtained for analysis. Quantitative methods were used for measurement of the new bone formation. Data were analyzed by analysis of variance followed by the Tukey test (P < 0.05). Radiographic results showed good radiopacity of the hydroxyapatite; however, radiolucent spots were seen between the hydroxyapatite granules in the diabetic groups, indicating infiltration of connective tissue. Microscopic results showed projections of newly formed bone from the margin of bone defect toward the implant. The quantity of newly formed bone was significantly higher (P < 0.05) than that observed in the diabetic groups. The recipient area of diabetic groups contained a larger amount of connective tissue as demonstrated by radiographic analyses. In conclusion, the osteogenesis guided by the properties of hydroxyapatite may even occur in bone suffering from the effects of diabetes, but the quantity of newly formed bone is lower, and the process is slower.
Pękala, P; Kiełbasa, G; Bogucka, K; Cempa, A; Olszewska, M; Konopka, T
The authors made an attempt to verify if a coconut can be used as a model of human skull to determine the homicide weapon. During our experiment 27 strike attempts were performed with the use of 9 different tools. Among them there were authentic murder weapons and instruments which had been used in similar experiments conducted on human skulls in 1955. Depending on the size of an area in contact with a coconut, weapons caused dents corresponding to the shape of a weapon, irregular fractures or long linear cracks. Our results have shown that coconut can be used as an inexpensive screening model of human skull, but only to determine fractures made by tools with small striking surface.
Torimitsu, Suguru; Nishida, Yoshifumi; Takano, Tachio; Koizumi, Yoshinori; Makino, Yohsuke; Yajima, Daisuke; Hayakawa, Mutsumi; Inokuchi, Go; Motomura, Ayumi; Chiba, Fumiko; Otsuka, Katsura; Kobayashi, Kazuhiro; Odo, Yuriko; Iwase, Hirotaro
The purpose of this research was to investigate the biomechanical properties of the adult human skull and the structural changes that occur with age in both sexes. The heads of 94 Japanese cadavers (54 male cadavers, 40 female cadavers) autopsied in our department were used in this research. A total of 376 cranial samples, four from each skull, were collected. Sample fracture load was measured by a bending test. A statistically significant negative correlation between the sample fracture load and cadaver age was found. This indicates that the stiffness of cranial bones in Japanese individuals decreases with age, and the risk of skull fracture thus probably increases with age. Prior to the bending test, the sample mass, the sample thickness, the ratio of the sample thickness to cadaver stature (ST/CS), and the sample density were measured and calculated. Significant negative correlations between cadaver age and sample thickness, ST/CS, and the sample density were observed only among the female samples. Computerized tomographic (CT) images of 358 cranial samples were available. The computed tomography value (CT value) of cancellous bone which refers to a quantitative scale for describing radiodensity, cancellous bone thickness and cortical bone thickness were measured and calculated. Significant negative correlation between cadaver age and the CT value or cortical bone thickness was observed only among the female samples. These findings suggest that the skull is substantially affected by decreased bone metabolism resulting from osteoporosis. Therefore, osteoporosis prevention and treatment may increase cranial stiffness and reinforce the skull structure, leading to a decrease in the risk of skull fractures.
Gawlikowska, A; Szczurowski, J; Czerwiński, F; Miklaszewska, D; Adamiec, E; Dzieciołowska, E
The analysis of fluctuating asymmetry (FA) allows for estimating the influence of stress factors on human development and allows to evaluate resistance to stress. FA is often used as a marker of prenatal stress. The aim of this work is to estimate the symmetry of skulls from selected historic human populations and to analyse changes in their morphology which have taken place over centuries. The studied material consisted of two skull samples - a modern sample containing 82 skulls and a medieval sample of 77 skulls from Gródek on the Bug River. Radiographs were taken in postero-anterior (P-A) and base projections. Images were scanned and calibrated by means of MicroStation 95 Academic Edition software. Measurements of the skull images were used to estimate FA. All data were analysed statistically. The skulls in both samples showed asymmetry. The levels of FA varied in different skull regions. A high level of FA in the calvaria and a low asymmetry for the facial part of skull is characteristic of modern skulls. In medieval skulls these relations are inverted. The higher value of FA in modern skulls is an evidence of a higher level of developmental stress in the modern population as well as of its lesser abilities to resist stress.
Neville, J. P.
One objective is to demonstrate the way crystals grow and how they affect the behavior of material. Another objective is to compare the growth of crystals in metals and nonmetals. The procedures, which involve a supersaturated solution of a salt that will separate into crystals on cooling and the pouring off of an eutectic solution to expose the crystals formed by a solid solution when an alloy of two metals forms a solid and eutectic solution on cooling, are described.
Zhang, Ziqun; Zhang, Ran; Song, Zhijian
Skull defect reconstruction is an important aspect of surgical repair. Historically, a skull defect prosthesis was created by the mirroring technique, surface fitting, or formed templates. These methods are not based on the anatomy of the individual patient's skull, and therefore, the prosthesis cannot precisely correct the defect. This study presented a new hybrid level set model, taking into account both the global optimization region information and the local accuracy edge information, while avoiding re-initialization during the evolution of the level set function. Based on the new method, a skull defect was reconstructed, and the skull prosthesis was produced by rapid prototyping technology. This resulted in a skull defect prosthesis that well matched the skull defect with excellent individual adaptation.
Komisar, A.; Silver, C.; Kalnicki, S.
Osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing.
The central skull base (CSB) constitutes a frontier between the extracranial head and neck and the middle cranial fossa. The anatomy of this region is complex, containing most of the bony foramina and canals of the skull base traversed by several neurovascular structures that can act as routes of spread for pathologic processes. Lesions affecting the CSB can be intrinsic to its bony-cartilaginous components; can arise from above, within the intracranial compartment; or can arise from below, within the extracranial head and neck. Crosssectional imaging is indispensable in the diagnosis, treatment planning, and follow-up of patients with CSB lesions. This review focuses on a systematic approach to this region based on an anatomic division that takes into account the major tissue constituents of the CSB.
The central skull base (CSB) constitutes a frontier between the extracranial head and neck and the middle cranial fossa. The anatomy of this region is complex, containing most of the bony foramina and canals of the skull base traversed by several neurovascular structures that can act as routes of spread for pathologic processes. Lesions affecting the CSB can be intrinsic to its bony-cartilaginous components; can arise from above, within the intracranial compartment; or can arise from below, within the extracranial head and neck. Crosssectional imaging is indispensable in the diagnosis, treatment planning, and follow-up of patients with CSB lesions. This review focuses on a systematic approach to this region based on an anatomic division that takes into account the major tissue constituents of the CSB.
Cherekaev, V A; Gol'bin, D A; Belov, A I; Radchenkov, N S; Lasunin, N V; Vinokurov, A G
The paper is written in the lecture format and dedicated to one of the main basal approaches, the orbitozygomatic approach, that has been widely used by neurosurgeons for several decades. The authors describe the historical background of the approach development and the surgical technique features and also analyze the published data about application of the orbitozygomatic approach in surgery for skull base tumors and cerebral aneurysms.
Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy
The effect of head mass on its biomechanical response during lateral impact to the head is investigated in this computational study. The mass of the head of a state-of-the-art validated finite element head model is altered by ± 10 % from the base value of 4.7 kg. Numerical simulations of lateral head impacts for 30 cases (representing 15 human cadaver experiments × 2 mass configurations) are performed using the LS-DYNA solver at different velocities ranging from 2.4 to 6.5 m/s and three impacting conditions representing different stiffness and shapes of the contact/impact surfaces. Results are compared with the original model using the baseline head mass, thus resulting in a total of 45 simulations. Present findings show that the head mass has greater influence for peak interaction forces and the force has a greater dependency on stiffness of contact surface than the shape. Mass variations have also influence on skull strain energy. Regardless of increase/decrease in skull strain energy influenced by head mass variations used in the computational study, the 50 % fracture tolerance limit was unaltered, which was 544 mJ. The present study gives a better understanding of the mechanism of temporo-parietal skull impact.
Arishima, Hidetaka; Akazawa, Ayumi; Kikuta, Ken-Ichiro
We report a case of a 7-year-old child with a cranial deformity secondary to a craniotomy for an intracranial hematoma. He suffered from an acute epidural hematoma with a lineal fracture of the right temporal bone following a severe head injury. A large question mark-shaped skin flap with the periosteum and temporal muscle was created for a decompressive craniectomy; however, neither the acute epidural hematoma nor brain swelling was severe, and we performed a small craniotomy compared with the skin flap without a decompressive craniectomy. Eighteen months after the operation, he complained of skull deformity with a mild depression of the forehead. Axial and 3-dimensional computed tomography showed thinness and subsidence of the frontoparietal bone around the replaced bone flap, corresponding to the skin flap with the periosteum defect. We suggest that the periosteum defect following creation of the skin flap during surgery prevented normal growth of the skull, which caused the thinness and subsidence of the frontoparietal bone. Preservation and cooptation of the periosteum should be performed during neurological surgeries in babies and children to prevent skull deformity.
Dobre, Mircea C; Fischbein, Nancy
Imaging of the skull base presents many challenges due to its anatomical complexity, numerous normal variants and lack of familiarity to many radiologists. As the skull base is a region which is not amenable to physical examination and as lesions of the skull base are generally difficult to biopsy and even more difficult to operate on, the radiologist plays a major role in directing patient management via accurate image interpretation. Knowledge of the skull base should not be limited to neuroradiologists and head and neck radiologists, however, as the central skull base is routinely included in the field of view when imaging the brain, cervical spine, or head and neck with computed tomography or magnetic resonance imaging, and hence, its nuances should be familiar to general radiologists as well. We herein review the imaging findings of a subcategory of lesions of the central skull base, the 'do not touch' lesions.
Kettner, Mattias; Schmidt, Peter; Potente, Stefan; Ramsthaler, Frank; Schrodt, Michael
Rapid prototyping (RP) comprises a variety of automated manufacturing techniques such as selective laser sintering (SLS), stereolithography, and three-dimensional printing (3DP), which use virtual 3D data sets to fabricate solid forms in a layer-by-layer technique. Despite a growing demand for (virtual) reconstruction models in daily forensic casework, maceration of the skull is frequently assigned to ensure haptic evidence presentation in the courtroom. Owing to the progress in the field of forensic radiology, 3D data sets of relevant cases are usually available to the forensic expert. Here, we present a first application of RP in forensic medicine using computed tomography scans for the fabrication of an SLS skull model in a case of fatal hammer impacts to the head. The report is intended to show that this method fully respects the dignity of the deceased and is consistent with medical ethics but nevertheless provides an excellent 3D impression of anatomical structures and injuries.
Policeni, Bruno A; Smoker, Wendy R K
The skull base is a critical landmark, separating intracranial from extracranial structures. This intricate anatomic structure has several foramina and crossing structures, which can be a challenge for novices. Comprehensive anatomic knowledge is critical for narrowing the differential diagnosis of lesions that may affect the skull base. These lesions can be divided into major categories to help in a systematic approach for skull base pathology evaluation.
Raymond, David; Van Ee, Chris; Crawford, Gregory; Bir, Cynthia
Less-lethal ballistic projectiles are used by police personnel to temporarily incapacitate suspects. While the frequency of these impacts to the head is low, they account for more serious injuries than impacts to any other body region. As a result, there is an urgent need to assess the tolerance of the head to such impacts. The focus of this study was to investigate the tolerance of the temporo-parietal skull to blunt ballistic impact and establish injury criteria for risk assessment. Seven unembalmed isolated cadaver heads were subjected to fourteen impacts. Specimens were instrumented with a nine-accelerometer array as well as strain gages surrounding the impact site. Impacts were performed with a 38 mm instrumented projectile at velocities ranging from 18 to 37 m/s. CT images and autopsies were performed to document resulting fractures. Peak fracture force for the seven resulting fractures was 5633+/-2095 N. Peak deformation for fracture-producing impacts was 7.8+/-3.2 mm. The blunt criterion (BC), peak force and principal strain were determined to be the best predictors of depressed comminuted fractures. Temporo-parietal tolerance levels were consistent with previous studies. An initial force tolerance level of 2346 N is established for the temporo-parietal region for blunt ballistic impact with a 38 mm diameter impactor.
Fanous, Andrew A; White, Timothy G; Hirsch, Matthew B; Chakraborty, Shamik; Costantino, Peter D; Langer, David J; Boockvar, John A
Intraoperative image-guided navigation has revolutionized neurosurgery. It undoubtedly increases the surgeon's confidence and the perception of safety. While fiducials and facial masks are currently the most widely used tools for intraoperative navigation, their use is associated with certain complications. For instance, such tools require rigid fixation of the head, which increases the risk of skull fractures and epidural hematomas, and decreases both surgical flexibility and surgeon's comfort. In addition, the use of a facial mask is at times undesirable, as it may represent an obstacle during surgeries involving the face and forehead. Furthermore, the use of these devices requires additional preoperative magnetic resonance imaging in the period immediately prior to the surgery, which is not cost-effective. In this case series, we present three cases that illustrate the usage of a skull-mounted tracker for image-guided navigation for anterior skull base surgery and ventricular catheter placement procedures. This system obviates the need for fiducials or face masks during the surgical procedure itself, and allows for the performance of facial incisions using the Weber-Ferguson approach. Moreover, our technique permits free movement of the head during surgery, which in turn facilitates the exposure of head-and-neck lesions and expedites the approach to ventricular catheter placement. Our case series demonstrates the precision and ease of our technique, which is less time-consuming and less cumbersome than the traditional frame-based stereotaxy. In addition, the skull-mounted tracker system allows improved anatomical localization and shorter operating time, while avoiding the complications associated with the use of rigid fixating head frames.
... Journal of Hand Surgery (JHS) Home Anatomy Shoulder Fractures Email to a friend * required fields From * To * ... create difficulty with its function. Types of Shoulder Fractures The type of fracture varies by age. Most ...
Stress fractures Overview By Mayo Clinic Staff Stress fractures are tiny cracks in a bone. They're caused by ... up and down or running long distances. Stress fractures can also arise from normal use of a ...
Greenstick fractures Overview By Mayo Clinic Staff A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try ...
Lauf, Robert J.; Heestand, Richard L.
A method of skull-melting comprises the steps of: a. providing a vessel adapted for a skull-melting process, the vessel having an interior, an underside, and an orifice in connecting the interior and the underside; b. disposing a waveguide in the orifice so that the waveguide protrudes sufficiently into the interior to interact with the skull-melting process; c. providing a signal energy transducer in signal communication with the waveguide; d. introducing into the vessel a molten working material; e. carrying out the skull-melting process so that a solidified skull of the working material is formed, the skull and the vessel having an interface therebetween, the skull becoming fused to the waveguide so the signal energy can be transmitted through the waveguide and the skull without interference from the interface; f. activating the signal energy transducer so that a signal is propagated through the waveguide; and, g. controlling at least one variable of the skull-melting process utilizing feedback information derived from the propagated signal energy.
Vaesen, F; Thimmesch, M; Born, J; Misson, J-P
The lacunar skull is a radiologic description characterised by the presence of lacunae in the cranial vault. Its physiopathology remains up to now poorly understood; it is mostly associated with neural tube defects. The association of a lacunar skull with a craniosynostosis has rarely been described in the literature. The case of a 9-month-old patient presenting a multisutural craniosynostosis with a lacunar skull is reported in this article. The surgical treatment allowed to remodel the skull and to hope for a spontaneous regression of the lacunae.
Lauf, R.J.; Heestand, R.L.
A method of skull-melting comprises the steps of: (a) providing a vessel adapted for a skull-melting process, the vessel having an interior, an underside, and an orifice connecting the interior and the underside; (b) disposing a waveguide in the orifice so that the waveguide protrudes sufficiently into the interior to interact with the skull-melting process; (c) providing a signal energy transducer in signal communication with the waveguide; (d) introducing into the vessel a molten working material; (e) carrying out the skull-melting process so that a solidified skull of the working material is formed, the skull and the vessel having an interface therebetween, the skull becoming fused to the waveguide so the signal energy can be transmitted through the waveguide and the skull without interference from the interface; (f) activating the signal energy transducer so that a signal is propagated through the waveguide; and, (g) controlling at least one variable of the skull-melting process utilizing feedback information derived from the propagated signal energy.
Ulinuha, M. A.; Yuniarno, E. M.; Nugroho, S. M. S.; Hariadi, M.
Extraction of the outer contour of the skull is an important step in craniofacial reconstruction. The outer contour is required for surface reconstruction of the skull. In this paper, we propose a method to extract the outer contour of the skull. The extraction process consists of four stages: defining the region of interest, segmentation of the bone, noise removal and extraction of the outer contour based on scanning from the four sides of the image. The proposed method successfully extracts the outermost contour of the skull and avoids redundant data.
The adaptation of cetaceans to aquatic life habits is reflected, in their nasal region, in three marked changes from the original relations found in land mammals. These changes include (1) the loss of the sense of smell, (2) translocation of the nostrils from the tip of the rostrum to the vertex of the head, and (3) elongation of the anterior head to form a rostrum protruding far towards anterior. The morphogenetic processes taking place during embryogenesis of the nasal skull play a decisive part in the development of all these changes. The lateral parts of the embryonic nasal capsule, encompassing the nasal passages, change their position from horizontal to vertical. At the same time, the structures of the original nasal floor (the solum nasi) are shifted in front of the nasal passages towards the rostrum. The structures of the original nasal roof (the tectum nasi) and of the nasal side wall (the paries nasi) are translocated behind the nasal passages towards the neurocranium. The medial nasal septum (the septum nasi) mostly loses its connection to the nasal passages and is produced into a point protruding far towards anterior. The transformed embryonic nasal skull of the Cetacea can be divided into three sections: 1. The median structures. These include the cartilaginous structures, viz., the rostrum nasi, the septum interorbitale and the spina mesethmoidalis, which are accompanied by the dermal bones, the vomer and the praemaxillare. In adult cetaceans the rostrum nasi is mostly preserved as a robust cartilage of the skull, which may possibly serve as a sound transmitting structure of the sonar system, or it may be responsible for the sensing of water streams and vibrations. 2. The posterior side wall structures. These include the following cartilaginous structures that are mostly heavily reduced or mutually fused: the cupula nasi anterior, the tectum nasi, the lamina cribrosa, the paries nasi, the commissura orbitonasalis, the cupula nasi posterior, the
Schulz-Ertner, Daniela . E-mail: Daniela.Ertner@med.uni-heidelberg.de; Nikoghosyan, Anna; Hof, Holger; Didinger, Bernd; Combs, Stephanie E.; Jaekel, Oliver; Karger, Christian P.; Edler, Lutz; Debus, Juergen
Purpose: To evaluate the effectiveness and toxicity of carbon ion radiotherapy in chondrosarcomas of the skull base. Patients and Methods: Between November 1998 and September 2005, 54 patients with low-grade and intermediate-grade chondrosarcomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft fuer Schwerionenforschung in Darmstadt, Germany. All patients had gross residual tumors after surgery. Median total dose was 60 CGE (weekly fractionation 7 x 3.0 CGE). All patients were followed prospectively in regular intervals after treatment. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) score. Results: Median follow-up was 33 months (range, 3-84 months). Only 2 patients developed local recurrences. The actuarial local control rates were 96.2% and 89.8% at 3 and 4 years; overall survival was 98.2%at 5 years. Only 1 patient developed a mucositis CTCAE Grade 3; the remaining patients did not develop any acute toxicities >CTCAE Grade 2. Five patients developed minor late toxicities (RTOG/EORTC Grades 1-2), including bilateral cataract (n = 1), sensory hearing loss (n = 1), a reduction of growth hormone (n = 1), and asymptomatic radiation-induced white matter changes of the adjacent temporal lobe (n = 2). Grade 3 late toxicity occurred in 1 patient (1.9%) only. Conclusions: Carbon ion RT is an effective treatment for low- and intermediate-grade chondrosarcomas of the skull base offering high local control rates with low toxicity.
Bever, G S; Lyson, Tyler R; Field, Daniel J; Bhullar, Bhart-Anjan S
Transitional fossils informing the origin of turtles are among the most sought-after discoveries in palaeontology. Despite strong genomic evidence indicating that turtles evolved from within the diapsid radiation (which includes all other living reptiles), evidence of the inferred transformation between an ancestral turtle with an open, diapsid skull to the closed, anapsid condition of modern turtles remains elusive. Here we use high-resolution computed tomography and a novel character/taxon matrix to study the skull of Eunotosaurus africanus, a 260-million-year-old fossil reptile from the Karoo Basin of South Africa, whose distinctive postcranial skeleton shares many unique features with the shelled body plan of turtles. Scepticism regarding the status of Eunotosaurus as the earliest stem turtle arises from the possibility that these shell-related features are the products of evolutionary convergence. Our phylogenetic analyses indicate strong cranial support for Eunotosaurus as a critical transitional form in turtle evolution, thus fortifying a 40-million-year extension to the turtle stem and moving the ecological context of its origin back onto land. Furthermore, we find unexpected evidence that Eunotosaurus is a diapsid reptile in the process of becoming secondarily anapsid. This is important because categorizing the skull based on the number of openings in the complex of dermal bone covering the adductor chamber has long held sway in amniote systematics, and still represents a common organizational scheme for teaching the evolutionary history of the group. These discoveries allow us to articulate a detailed and testable hypothesis of fenestral closure along the turtle stem. Our results suggest that Eunotosaurus represents a crucially important link in a chain that will eventually lead to consilience in reptile systematics, paving the way for synthetic studies of amniote evolution and development.
The skull of leporids (rabbits and hares) is highly transformed, typified by pronounced arching of the dorsal skull and ventral flexion of the facial region (i.e., facial tilt). Previous studies show that locomotor behavior influences aspects of cranial shape in leporids, and here we use an extensive 3D geometric morphometrics dataset to further explore what influences leporid cranial diversity. Facial tilt angle, a trait that strongly correlates with locomotor mode, significantly predicts the cranial shape variation captured by the primary axis of cranial shape space, and describes a small proportion (13.2%) of overall cranial shape variation in the clade. However, locomotor mode does not correlate with overall cranial shape variation in the clade, because there are two district morphologies of generalist species, and saltators and cursorial species have similar morphologies. Cranial shape changes due to phyletic size change (evolutionary allometry) also describes a small proportion (12.5%) of cranial shape variation in the clade, but this is largely driven by the smallest living leporid, the pygmy rabbit (Brachylagus idahoensis). By integrating phylogenetic history with our geometric morphometric data, we show that the leporid cranium exhibits weak phylogenetic signal and substantial homoplasy. Though these results make it difficult to reconstruct what the ‘ancestral’ leporid skull looked like, the fossil records suggest that dorsal arching and facial tilt could have occurred before the origin of the crown group. Lastly, our study highlights the diversity of cranial variation in crown leporids, and highlights a need for additional phylogenetic work that includes stem (fossil) leporids and includes morphological data that captures the transformed morphology of rabbits and hares. PMID:27688967
Parhizkar, Nooshin; Hiltzik, David H; Selesnick, Samuel H
Facial nerve rerouting techniques were developed to facilitate re-section of extensive tumors occupying the skull base. Facial nerve rerouting has its own limitations and risks, requiring microsurgical expertise, additional surgical time, and often some degree of facial nerve paresis. This article presents different degrees of anterior and posterior facial nerve rerouting, techniques of facial nerve rerouting, and a comprehensive review of outcomes. It then reviews anatomic and functional preservation of the facial nerve in acoustic neuroma resection, technical aspects of facial nerve dissection, intracranial facial nerve repair options, and outcomes for successful acoustic neuroma surgery.
Carr, Debra; Lindstrom, Anne-Christine; Jareborg, Andreas; Champion, Stephen; Waddell, Neil; Miller, David; Teagle, Michael; Horsfall, Ian; Kieser, Jules
Reports on penetrating ballistic head injuries in the literature are dominated by case studies of suicides; the penetrating ammunition usually being .22 rimfire or shotgun. The dominating cause of injuries in modern warfare is fragmentation and hence, this is the primary threat that military helmets protect the brain from. When helmets are perforated, this is usually by bullets. In combat, 20% of penetrating injuries occur to the head and its wounding accounts for 50% of combat deaths. A number of head simulants are described in the academic literature, in ballistic test methods for helmets (including measurement of behind helmet blunt trauma, BHBT) and in the 'open' and 'closed' government literature of several nations. The majority of these models are not anatomically correct and are not assessed with high-velocity rifle ammunition. In this article, an anatomically correct 'skull' (manufactured from polyurethane) and 'brain' (manufactured from 10%, by mass, gelatine) model for use in military wound ballistic studies is described. Filling the cranium completely with gelatine resulted in a similar 'skull' fracture pattern as an anatomically correct 'brain' combined with a representation of cerebrospinal fluid. In particular, posterior cranial fossa and occipital fractures and brain ejection were observed. This pattern of injury compared favourably to reported case studies of actual incidents in the literature.
Dannhauer, Moritz; Lanfer, Benjamin; Wolters, Carsten H; Knösche, Thomas R
We used computer simulations to investigate finite element models of the layered structure of the human skull in EEG source analysis. Local models, where each skull location was modeled differently, and global models, where the skull was assumed to be homogeneous, were compared to a reference model, in which spongy and compact bone were explicitly accounted for. In both cases, isotropic and anisotropic conductivity assumptions were taken into account. We considered sources in the entire brain and determined errors both in the forward calculation and the reconstructed dipole position. Our results show that accounting for the local variations over the skull surface is important, whereas assuming isotropic or anisotropic skull conductivity has little influence. Moreover, we showed that, if using an isotropic and homogeneous skull model, the ratio between skin/brain and skull conductivities should be considerably lower than the commonly used 80:1. For skull modeling, we recommend (1) Local models: if compact and spongy bone can be identified with sufficient accuracy (e.g., from MRI) and their conductivities can be assumed to be known (e.g., from measurements), one should model these explicitly by assigning each voxel to one of the two conductivities, (2) Global models: if the conditions of (1) are not met, one should model the skull as either homogeneous and isotropic, but with considerably higher skull conductivity than the usual 0.0042 S/m, or as homogeneous and anisotropic, but with higher radial skull conductivity than the usual 0.0042 S/m and a considerably lower radial:tangential conductivity anisotropy than the usual 1:10.
Wassef, Shafik N.; Batra, Pete S.; Barnett, Samuel
Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts. PMID:23346418
Ueki, Yushi; Matsuyama, Hiroshi; Morita, Yuka; Takahashi, Kuniyuki; Yamamoto, Yutaka; Takahashi, Sugata
Typical osteomyelitis is reportedly caused by Pseudomonous aeruginosa in elderly diabetic patients after malignant external otitis. Recently, complications have arisen due to the emergence of atypical osteomyelitis. We have experiensed 5 cases of skull base osteomyelitis at our hospital. All patients were male with a mean age of 75.2 years. Four patients had diabetes. Regarding the clinical and radiographic findings, patients 1, 2, and 3 had typical osteomyelitis after malignant external otitis, whereas patients 4 and 5 had atypical osteomyelitis without temporal bone findings. Sample culturing revealed Pseudomonas aeruginosa in 4 cases and Aspergillus in one. Intravenous antibiotics were administered to all patients. Two patients responded positively and survived, while 3 died. Typical osteomyelitis is reportedly caused by P. aeruginosa in elderly diabetic patients after malignant external otitis. Recently, complications have arisen due to the emergence of atypical osteomyelitis. The prognosis of skull base osteomyelitis is still poor in Japan. Early diagnosis and long-term antibiotic administration is required to improve outcome.
Background Forty dogs presented for brachycephalic airway obstructive syndrome with laryngeal collapse not over 1st degree (saccule eversion) underwent glottis endoscopic and radiographic skull measurements before surgery. Fifteen Pugs, fifteen French and ten English Bulldogs were included. The goals were prospectively to compare three common brachycephalic breeds for anatomical differences regarding glottis and skull measurements, and to assess if any correlation between glottis and skull measurements was present. Linear measurements were used to obtain glottis and skull indices. Correlations between glottis and skull indices and glottic measurements were evaluated. Finally, glottis indices were compared among the three breeds. Results No correlation was found for glottis and skull indices. The glottic index differed among the three breeds (smaller in Pugs and higher in English Bulldogs), ultimately representing a morphologic indicator of the different larynx shape in the three breeds (more rounded in English Bulldogs, more elliptical in Pugs and in-between in French Bulldogs). Conclusions The lack of correlation between skull/glottic indices does not support skull morphology as predictor of glottic morphology. As Pugs had the lowest glottic index, it may be speculated that Pugs’ original narrow glottic width may predispose to further progressive respiratory deterioration more easily than in the other two breeds. PMID:24410902
Moazen, Mehran; Curtis, Neil; O'Higgins, Paul; Evans, Susan E; Fagan, Michael J
The lepidosaurian skull has long been of interest to functional morphologists and evolutionary biologists. Patterns of bone loss and gain, particularly in relation to bars and fenestrae, have led to a variety of hypotheses concerning skull use and kinesis. Of these, one of the most enduring relates to the absence of the lower temporal bar in squamates and the acquisition of streptostyly. We performed a series of computer modeling studies on the skull of Uromastyx hardwickii, an akinetic herbivorous lizard. Multibody dynamic analysis (MDA) was conducted to predict the forces acting on the skull, and the results were transferred to a finite element analysis (FEA) to estimate the pattern of stress distribution. In the FEA, we applied the MDA result to a series of models based on the Uromastyx skull to represent different skull configurations within past and present members of the Lepidosauria. In this comparative study, we found that streptostyly can reduce the joint forces acting on the skull, but loss of the bony attachment between the quadrate and pterygoid decreases skull robusticity. Development of a lower temporal bar apparently provided additional support for an immobile quadrate that could become highly stressed during forceful biting.
Enchev, Yavor; Nedelkov, Grigoriy; Atanassova-Timeva, Nadezhda; Jordanov, Jordan
Paleoneurosurgery represents a comparatively new developing direction of neurosurgery dealing with archaeological skull and spine finds and studying their neurosurgical aspects. Artificial skull deformation, as a bone artifact, naturally has been one of the main paleoneurosurgical research topics. Traditionally, the relevant neurosurgical literature has analyzed in detail the intentional skull deformations in South America's tribes. However, little is known about the artificial skull deformations of the Proto-Bulgarians, and what information exists is mostly due to anthropological studies. The Proto-Bulgarians originated from Central Asia, and distributed their skull deformation ritual on the Balkan Peninsula by their migration and domination. Proto-Bulgarian artificial skull deformation was an erect or oblique form of the anular type, and was achieved by 1 or 2 pressure bandages that were tightened around a newborn's head for a sufficiently long period. The intentional skull deformation in Proto-Bulgarians was not associated with neurological deficits and/or mental retardation. No indirect signs of chronic elevated intracranial pressure were found on the 3D CT reconstruction of the artificially deformed skulls.
Ji, Songbai; Liu, Fenghong; Roberts, David; Hartov, Alex; Paulsen, Keith
Brain shift poses a significant challenge to accurate image-guided neurosurgery. To this end, finite element (FE) brain models have been developed to estimate brain motion during these procedures. The significance of the brain-skull boundary conditions (BCs) for accurate predictions in these models has been explored in dynamic impact and inertial rotation injury computational simulations where the results have shown that the brain mechanical response is sensitive to the type of BCs applied. We extend the study of brain-skull BCs to quasi-static brain motion simulations which prevail in neurosurgery. Specifically, a frictionless brain-skull BC using a contact penalty method master-slave paradigm is incorporated into our existing deformation forward model (forced displacement method). The initial brain-skull gap (CSF thickness) is assumed to be 2mm for demonstration purposes. The brain surface nodes are assigned as either fixed (at bottom along the gravity direction), free (at brainstem), with prescribed displacement (at craniotomy) or as slave nodes potentially in contact with the skull (all the remaining). Each slave node is assigned a penalty parameter (β=5) such that when the node penetrates the rigid body skull inner-surface (master surface), a contact force is introduced proportionally to the penetration. Effectively, brain surface nodes are allowed to move towards or away from the cranium wall, but are ultimately restricted from penetrating the skull. We show that this scheme improves the model's ability to represent the brain-skull interface.
Yamamoto, Yuhei; Minakawa, Hidehiko; Yoshida, Tetsunori; Igawa, Hiroharu; Sugihara, Tsuneki; Ohura, Takehiko; Nohira, Kunihiko
Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 × 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects. ImagesFigure 1Figure 2Figure 2Figure 3Figure 3Figure 4p228-aFigure 4Figure 4 PMID:17170915
Proposes the use of a series of 11 casts of fossil skulls as a method of teaching about the theory of human evolution. Students explore the questions of which skulls are "human" and which came first in Homo Sapien development, large brain or upright stance. (MDH)
al-Mefty, O; Borba, L A
Because of their critical location, invasive nature, and aggressive recurrence, skull base chordomas are challenging and, at times, frustrating tumors to treat. Both radical surgical removal and high-dose radiation therapy, particularly proton beam therapy, reportedly are effective in tumor control and improve survival rates. The authors posit that these tumors are best treated with radical surgery and proton-photon beam therapy. During the last 5 years, they treated 25 patients (15 females and 10 males) who harbored pathologically diagnosed skull base chordomas. The mean age of the patients was 38.4 years (range 8-61 years). Previous surgery or radiation therapy was performed at other institutions in seven and two patients, respectively. The authors performed 33 surgical procedures on 23 patients. Radical removal (defined as absence of residual tumor on operative inspection and postoperative imaging) was achieved in 10 patients; subtotal resection (defined as resection of > 90% of the tumor) was achieved in 11 patients; and partial resection (defined as resection of < 90% of the tumor) was achieved in two patients. Radical surgical removal included not only the excision of soft-tumor tissue, but also extensive drilling of the adjacent bone. Adjuvant therapy consisted of postoperative combined proton-photon beam therapy (given to 17 patients and planned for one patient) and conventional radiation therapy (two patients); three patients received no adjunct therapy. To date, four patients have died. One patient who had undergone previous surgery and sacrifice of the internal carotid artery died postoperatively from a massive stroke; one patient died from adenocarcinoma of the pancreas without evidence of recurrence; and two patients died at 25 and 39 months of recurrent tumor. Permanent neurological complications included third cranial nerve palsy (one patient) and hemianopsia (one patient); radiation necrosis occurred in three patients. Of the 21 patients followed
Peltola, Elina M; Koivikko, Mika P; Koskinen, Seppo K
Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15-80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.
Strong, E. Bradley
Frontal sinus injuries may range from isolated anterior table fractures resulting in a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. The risk of long-term morbidity can be significant. Optimal treatment strategies for the management of frontal sinus fractures remain controversial. However, it is critical to have a thorough understanding of frontal sinus anatomy as well as the current treatment strategies used to manage these injuries. A thorough physical exam and thin-cut, multiplanar (axial, coronal, and sagittal) computed tomography scan should be performed in all patients suspected of having a frontal sinus fracture. The most appropriate treatment strategy can be determined by assessing five anatomic parameters including the: frontal recess, anterior table integrity, posterior table integrity, dural integrity, and presence of a cerebrospinal fluid leak. A well thought out management strategy and meticulous surgical techniques are critical to success. The primary surgical goal is to provide a safe sinus while minimizing patient morbidity. This article offers an anatomically based treatment algorithm for the management of frontal sinus fractures and highlights the key steps to surgical repair. PMID:22110810
The practice of induced skull deformity has long existed in numerous disparate cultures, but for the first time in history it can be applied to adults. While extremely limited in application, some ideas have persisted in the far fringes of modern Western culture with remarkable tenacity. Practitioners of extreme body modification undergo procedures, outside the sphere of traditional medical practice, to make striking, permanent, nontraditional esthetic tissue distortions with the goal of transgressing societal norms. The International Trepanation Advocacy Group represents another example of a fringe cultural movement, whose goal, rather than being purely aesthetic in nature, is to promote elective trepanation as a method for achieving a heightened level of consciousness. Both movements have relatively short and well-defined histories. Despite their tiny numbers of adherents, neurosurgeons may be called on to address relevant patient concerns preprocedurally, or complications postprocedurally, and would benefit from awareness of these peculiar subcultures.
Chandler, J.R.; Grobman, L.; Quencer, R.; Serafini, A.
Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.
Herr, Marc W; Lin, Derrick T
The anatomical challenges of skull base surgery are well known. Furthermore, ablative and traumatic defects in this region produce complex reconstructive problems with a high risk of significant postoperative morbidity and mortality. Over the past two decades, microvascular free tissue reconstruction following open resection has been shown to improve outcomes and reduce complication rates when compared to the traditional use of pedicled flaps. The increasing use of free tissue transfer has been further strengthened by improved technical expertise and high flap success rates. Since the size and type of free tissue to be utilized must be individualized to each defect, the accomplished reconstructive surgeon should be extremely versatile and, by extension, facile with a several types of free flaps. Thus, four of the most commonly used flaps--the rectus abdominis, radial forearm, latissimus dorsi and anterolateral thigh flaps--are discussed.
Wang, Amy J; Zaidi, Hasan A; Laws, Edward D
While the endonasal approach to the skull base continues to advance, this paper invokes its long history. The centuries of medieval neuroanatomy and early neurosurgery enabled the conception of the first transfacial approaches in the late 1800s; Henry Schloffer performed the first transsphenoidal surgery in 1907. Although the procedure was initially met with much interest, Harvey Cushing eventually led the field of neurosurgery to abandon the transsphenoidal approach in the 1920s. The following three generations of neurosurgeons contained several key figures including Norman Dott, Gerard Guiot, and Jules Hardy who were steadfast in preserving the technique as well as in addressing its shortcomings. The endoscopic approach developed simultaneously, and advances in magnifying and fiberoptics further resolved limitations previously inherent to the transsphenoidal approach. At last, in the 1960s, the transsphenoidal approach entered its renaissance. Today, the momentum of its development persists in the endoscopic endonasal approach, which has recently expanded the indications for transsphenoidal surgery across the skull base, far beyond its original jurisdiction of the sella. Continued progress must not take for granted the rich history of the transsphenoidal approach, which was developed over centuries by surgeons around the world. The authors present the evolution of modern endonasal surgery as a dynamic interplay between technology, medicine, and surgery over the past 100 years. Progress can be attributed to courageous surgeons who affirmed their contemporary practices despite gaps in technology or medicine, and to visionary individuals who produced and incorporated new elements into transsphenoidal surgery. And so while the new endoscopic technique brings forth new challenges, its development reaffirms the principles laid down by the pioneers of transsphenoidal surgery.
Wagenmann, Martin; Schipper, Jörg
The indications for endonasal endoscopic approaches to diseases of the skull base and its adjacent structures have expanded considerably during the last decades. This is not only due to improved technical possibilities such as intraoperative navigation, the development of specialized instruments, and the compilation of anatomical studies from the endoscopic perspective but also related to the accumulating experience with endoscopic procedures of the skull base by multidisciplinary centers. Endoscopic endonasal operations permit new approaches to deeply seated lesions and are characterized by a reduced manipulation of neurovascular structures and brain parenchyma while at the same time providing improved visualization. They reduce the trauma caused by the approach, avoid skin incisions and minimize the surgical morbidity. Transnasal endoscopic procedures for the closure of small and large skull base defects have proven to be reliable and more successful than operations with craniotomies. The development of new local and regional vascularized flaps like the Hadad-flap have contributed to this. These reconstructive techniques are furthermore effectively utilized in tumor surgery in this region. This review delineates the classification of expanded endonasal approaches in detail. They provide access to lesions of the anterior, middle and partly also to the posterior cranial fossa. Successful management of these complex procedures requires a close interdisciplinary collaboration as well as continuous education and training of all team members. PMID:22558058
Van Loenen, R. E.; Selner, Gary; Bryant, W.A.
The Skull Creek quadrangle is in northwestern Colorado a few miles north of Rangely. The prominent structural feature of the Skull Creek quadrangle is the Skull Creek monocline. Pennsylvanian rocks are exposed along the axis of the monocline while hogbacks along its southern flank expose rocks that are from Permian to Upper Cretaceous in age. The Wolf Creek monocline and the Wolf Creek thrust fault, which dissects the monocline, are salient structural features in the northern part of the quadrangle. Little or no mineral potential exists within the quadrangle. A geologic map of the Lazy Y Point quadrangle, which is adjacent to the Skull Creek quadrangle on the west, is also available (Geologic Investigations Series I-2646). This companian map shows similar geologic features, including the western half of the Skull Creek monocline. The geology of this quadrangle was mapped because of its proximity to Dinosaur National Monument. It is adjacent to quadrangles previously mapped to display the geology of this very scenic and popular National Monument. The Skull Creek quadrangle includes parts of the Skull Creek Wilderness Study Area, which was assessed for its mineral resource potential.
Serracino, Hilary S; Kleinschmidt-Demasters, B K
Skull and dura serve as effective barriers to penetration by most tumors, often preventing masses originating intracranially from extending into the contiguous bone and soft tissues, or those arising in head and neck regions from extending into the dura and brain tissue. We review our 15-year experience with extracranial tumors that had sufficiently invaded adjacent skull, dura, or brain from the "outside-in" to require a neurosurgeon to participate in the surgical resection and discuss our 40 cases in context with the literature. Sinonasal-origin tumors (n = 17) and cutaneous tumors (n = 10) were the most frequent skull-invaders. Most of the cutaneous tumor types were squamous cellcarcinomas (n = 9); diverse sinonasal-origin types included 4 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 sinonasal undifferentiated carcinomas, 2 sinonasal adenocarcinomas, and single examples each of sinonasal-origin hemangiopericytoma, solitary fibrous tumor, melanoma, mucocele, and teratocarcinoma. There were 9olfactory neuroblastomas, and middle ear-origin basal cell carcinoma,recurrent glomus jugulare, and orbital malignant hidradenoma were also seen. Unique tumors included a cutaneous cylindroma invasive of skull convexity occurring in familial cylindromatosis and a ganglioneuroma of the middle ear with massive bilateral skull base extension. Convexity dural spread, a seldom-reported pattern of dissemination, was seen in 1 olfactory neuroblastoma and 1 adenoid cystic carcinoma. The ability to show skull/dural invasion did not correlate with specific histopathologic features; even benign tumor types can show skull/dural penetration.
Kirsch, Claudia F.E.
Introduction Over the past 20 years, magnetic resonance imaging (MRI) has advanced due to new techniques involving increased magnetic field strength and developments in coils and pulse sequences. These advances allow increased opportunity to delineate the complex skull base anatomy and may guide the diagnosis and treatment of the myriad of pathologies that can affect the skull base. Objectives The objective of this article is to provide a brief background of the development of MRI and illustrate advances in skull base imaging, including techniques that allow improved conspicuity, characterization, and correlative physiologic assessment of skull base pathologies. Data Synthesis Specific radiographic illustrations of increased skull base conspicuity including the lower cranial nerves, vessels, foramina, cerebrospinal fluid (CSF) leaks, and effacement of endolymph are provided. In addition, MRIs demonstrating characterization of skull base lesions, such as recurrent cholesteatoma versus granulation tissue or abscess versus tumor, are also provided as well as correlative clinical findings in CSF flow studies in a patient pre- and post-suboccipital decompression for a Chiari I malformation. Conclusions This article illustrates MRI radiographic advances over the past 20 years, which have improved clinicians' ability to diagnose, define, and hopefully improve the treatment and outcomes of patients with underlying skull base pathologies. PMID:25992137
Witton, Mark P
The skull of the Cretaceous pterosaur Istiodactylus latidens, a historically important species best known for its broad muzzle of interlocking, lancet-shaped teeth, is almost completely known from the broken remains of several individuals, but the length of its jaws remains elusive. Estimates of I. latidens jaw length have been exclusively based on the incomplete skull of NHMUK R3877 and, perhaps erroneously, reconstructed by assuming continuation of its broken skull pieces as preserved in situ. Here, an overlooked jaw fragment of NHMUK R3877 is redescribed and used to revise the skull reconstruction of I. latidens. The new reconstruction suggests a much shorter skull than previously supposed, along with a relatively tall orbital region and proportionally slender maxilla, a feature documented in the early 20(th) century but ignored by all skull reconstructions of this species. These features indicate that the skull of I. latidens is particularly distinctive amongst istiodactylids and suggests greater disparity between I. latidens and I. sinensis than previously appreciated. A cladistic analysis of istiodactylid pterosaurs incorporating new predicted I. latidens skull metrics suggests Istiodactylidae is constrained to five species (Liaoxipterus brachyognathus, Lonchengpterus zhoai, Nurhachius ignaciobritoi, Istiodactylus latidens and Istiodactylus sinensis) defined by their distinctive dentition, but excludes the putative istiodactylids Haopterus gracilis and Hongshanopterus lacustris. Istiodactylus latidens, I. sinensis and Li. brachyognathus form an unresolved clade of derived istiodactylids, and the similarity of comparable remains of I. sinensis and Li. brachyognathus suggest further work into their taxonomy and classification is required. The new skull model of I. latidens agrees with the scavenging habits proposed for these pterosaurs, with much of their cranial anatomy converging on that of habitually scavenging birds.
Tavakolian, Pantea; Todd, Rhiannon; Kosik, Ivan; Chamson-Reig, Astrid; Vasefi, Fartash; St. Lawrence, Keith; Carson, Jeffrey J. L.
Photoacoustic imaging (PAI) has been proposed as a non-invasive technique for the diagnosis and monitoring of disorders in the neonatal brain. However, PAI of the brain through the intact skull is challenging due to reflection and attenuation of photoacoustic pressure waves by the skull bone. The objective of this work was to develop a phantom for testing the potential limits the skull bone places on PAI of the neonatal brain. Our approach was to make acoustic measurements on materials designed to mimic the neonatal skull bone and construct a semi-realistic phantom. A water tank and two ultrasound transducers were utilized to measure the ultrasound insertion loss (100 kHz to 5MHz) of several materials. Cured mixtures of epoxy and titanium dioxide powder provided the closest acoustic match to neonatal skull bone. Specifically, a 1.4-mm thick sample composed of 50% (by mass) titanium dioxide powder and 50% epoxy was closest to neonatal skull bone in terms of acoustic insertion loss. A hemispherical skull phantom (1.4 mm skull thickness) was made by curing the epoxy/titanium dioxide powder mixture inside a mold. The mold was constructed using 3D prototyping techniques and was based on the hairless head of a realistic infant doll. The head was scanned to generate a 3D model, which in turn was used to build a 3D CAD version of the mold. The mold was CNC machined from two solid blocks of Teflon®. The neonatal skull phantom will enable the study of the propagation of photoacoustic pressure waves under a variety of experimental conditions.
Richtsmeier, Joan T; Flaherty, Kevin
The brain originates relatively early in development from differentiated ectoderm that forms a hollow tube and takes on an exceedingly complex shape with development. The skull is made up of individual bony elements that form from neural crest- and mesoderm-derived mesenchyme that unite to provide support and protection for soft tissues and spaces of the head. The meninges provide a protective and permeable membrane between brain and skull. Across evolutionary and developmental time, dynamic changes in brain and skull shape track one another so that their integration is evidenced in two structures that fit soundly regardless of changes in biomechanical and physiologic functions. Evidence for this tight correspondence is also seen in diseases of the craniofacial complex that are often classified as diseases of the skull (e.g., craniosynostosis) or diseases of the brain (e.g., holoprosencephaly) even when both tissues are affected. Our review suggests a model that links brain and skull morphogenesis through coordinated integration of signaling pathways (e.g., FGF, TGFβ, Wnt) via processes that are not currently understood, perhaps involving the meninges. Differences in the earliest signaling of biological structure establish divergent designs that will be enhanced during morphogenesis. Signaling systems that pattern the developing brain are also active in patterning required for growth and assembly of the skull and some members of these signaling families have been indicated as causal for craniofacial diseases. Because cells of early brain and skull are sensitive to similar signaling families, variation in the strength or timing of signals or shifts in patterning boundaries that affect one system (neural or skull) could also affect the other system and appropriate co-adjustments in development would be made. Interactions of these signaling systems and of the tissues that they pattern are fundamental to the consistent but labile functional and structural association
Montes-Restrepo, Victoria; van Mierlo, Pieter; Strobbe, Gregor; Staelens, Steven; Vandenberghe, Stefaan; Hallez, Hans
Electroencephalographic source localization (ESL) relies on an accurate model representing the human head for the computation of the forward solution. In this head model, the skull is of utmost importance due to its complex geometry and low conductivity compared to the other tissues inside the head. We investigated the influence of using different skull modeling approaches on ESL. These approaches, consisting in skull conductivity and geometry modeling simplifications, make use of X-ray computed tomography (CT) and magnetic resonance (MR) images to generate seven different head models. A head model with an accurately segmented skull from CT images, including spongy and compact bone compartments as well as some air-filled cavities, was used as the reference model. EEG simulations were performed for a configuration of 32 and 128 electrodes, and for both noiseless and noisy data. The results show that skull geometry simplifications have a larger effect on ESL than those of the conductivity modeling. This suggests that accurate skull modeling is important in order to achieve reliable results for ESL that are useful in a clinical environment. We recommend the following guidelines to be taken into account for skull modeling in the generation of subject-specific head models: (i) If CT images are available, i.e., if the geometry of the skull and its different tissue types can be accurately segmented, the conductivity should be modeled as isotropic heterogeneous. The spongy bone might be segmented as an erosion of the compact bone; (ii) when only MR images are available, the skull base should be represented as accurately as possible and the conductivity can be modeled as isotropic heterogeneous, segmenting the spongy bone directly from the MR image; (iii) a large number of EEG electrodes should be used to obtain high spatial sampling, which reduces the localization errors at realistic noise levels.
Schären, S; Jeanneret, B
Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.
... From Brain Injury Additional Content Medical News Rib Fractures By Thomas G. Weiser, MD, MPH, Department of ... Hemothorax Injury to the Aorta Pulmonary Contusion Rib Fractures Tension Pneumothorax Traumatic Pneumothorax (See also Introduction to ...
... Thumb Arthritis Thumb Sprains Trigger Finger Tumors Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ... Tunnel Ganglion Cysts Thumb Arthritis Trigger Finger Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ...
Carr, M. M.; Freiberg, A.; Martin, R. D.
Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509
Morani, Ajaykumar C; Ramani, Nisha S; Wesolowski, Jeffrey R
Accurate delineation, diagnosis, and treatment planning of skull base lesions require knowledge of the complex anatomy of the skull base. Because the skull base cannot be directly evaluated, imaging is critical for the diagnosis and management of skull base diseases. Although computed tomography (CT) is excellent for outlining the bony detail, magnetic resonance (MR) imaging provides better soft tissue detail and is helpful for evaluating the adjacent meninges, brain parenchyma, and bone marrow of the skull base. Thus, CT and MR imaging are often used together for evaluating skull base lesions. This article focuses on the radiologic anatomy of the skull base pertinent to MR imaging evaluation.
... x-ray of the skull shows an eosinophilic granuloma (a lesion made-up of a type of ... This condition can range from a single eosinophilic granuloma to massive infiltration of skin, bone, and body ...
Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl-Michael
Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. PMID:27453759
Gaudio, Daniel; Olivieri, Lara; De Angelis, Danilo; Poppa, Pasquale; Galassi, Andrea; Cattaneo, Cristina
Craniofacial superimposition is a technique potentially useful for the identification of unidentified human remains if a photo of the missing person is available. We have tested the reliability of the 2D-3D computer-aided nonautomatic superimposition techniques. Three-dimension laser scans of five skulls and ten photographs were overlaid with an imaging software. The resulting superimpositions were evaluated using three methods: craniofacial landmarks, morphological features, and a combination of the two. A 3D model of each skull without its mandible was tested for superimposition; we also evaluated whether separating skulls by sex would increase correct identifications. Results show that the landmark method employing the entire skull is the more reliable one (5/5 correct identifications, 40% false positives [FP]), regardless of sex. However, the persistence of a high percentage of FP in all the methods evaluated indicates that these methods are unreliable for positive identification although the landmark-only method could be useful for exclusion.
Kneipp, Moritz; Turner, Jake; Estrada, Héctor; Rebling, Johannes; Shoham, Shy; Razansky, Daniel
Despite the great promise behind the recent introduction of optoacoustic technology into the arsenal of small-animal neuroimaging methods, a variety of acoustic and light-related effects introduced by adult murine skull severely compromise the performance of optoacoustics in transcranial imaging. As a result, high-resolution noninvasive optoacoustic microscopy studies are still limited to a thin layer of pial microvasculature, which can be effectively resolved by tight focusing of the excitation light. We examined a range of distortions introduced by an adult murine skull in transcranial optoacoustic imaging under both acoustically- and optically-determined resolution scenarios. It is shown that strong low-pass filtering characteristics of the skull may significantly deteriorate the achievable spatial resolution in deep brain imaging where no light focusing is possible. While only brain vasculature with a diameter larger than 60 µm was effectively resolved via transcranial measurements with acoustic resolution, significant improvements are seen through cranial windows and thinned skull experiments.
Peterson, K Linnea; Fenn, Joanne
This article provides an overview of considerations in the evaluation and treatment of lower cranial nerve deficits, specifically in cranial nerves IX, X, and XII, in the context of skull base tumors and their treatment.
Verhoff, Marcel A; Durschnabel, Melanie; Kreutz, Kerstin
In the course of an exhumation performed 5.5 years after death, several bone fragments were uncovered during the excavation of the clay-rich soil. Amongst others, there was a large piece of the frontal neurocranium. In addition, a so-called coffin stain was discernible. The exhumed coffin was intact. The forensic autopsy revealed a complete corpse with distinct adipocere formation. Consultation with the cemetery administration allowed the conclusion that the additional bone fragments were from the first use of the grave approximately 100 years ago. The heavily soil-encrusted skull fragment bore clear signs of a half sharp force, that could immediately be classified as postmortem. The pattern of injury pointed to an excavator as the cause. However, the question arose whether the postmortem trauma occurred 5.5 years ago during the excavation of the grave or during the current exhumation. First the skull fragment was dried. However, it was then impossible to remove the clay-rich soil without damaging the bone. The fragment was therefore carefully washed and dried again. The cut and fracture areas then showed distinctly lighter surfaces than the rest of the bone, which pointed to the exhumation as the time of origin. For comparison, fresh injuries were inflicted with a hatchet. These distinctly showed even lighter surfaces, so that the time of origin could be assumed to have been during the excavation of the grave 5.5 years ago.
Huffman, O Frank; Shipman, Pat; Hertler, Christine; de Vos, John; Aziz, Fachroel
To resolve ambiguities in the literature, we detail the discovery history of the Mojokerto child's skull (Perning 1), employing letters, maps, photographs, reports, and newspaper accounts not previously used for this purpose. Andoyo, an experienced vertebrate-fossil collector with the Geological Survey of the Netherlands Indies, found the skull on February 13, 1936, while collecting for Johan Duyfjes, who had mapped the field area geologically. On February 18-19 Andoyo sent the fossil and a 1:25,000-topographic map showing the discovery point to Survey headquarters. The locality lies between Perning and Sumbertengu villages, approximately 10km northeast of Mojokerto city, East Java. G.H. Ralph von Koenigswald, Survey paleontologist, identified the specimen as Pithecanthropus and then named it Homo modjokertensis (it is now accepted as Homo erectus). Unfortunately he confused the discovery record in a March 28 newspaper article by characterizing the skull as a "surface find" [Dutch: oppervlaktevondst] while also attributing it to ancient beds. von Koenigswald probably had insufficient basis for either assertion, having not yet talked to Andoyo or Duyfjes. Eugene Dubois challenged von Koenigswald on the "surface-find" issue, Andoyo was consulted, and Duyfjes went to the site. Duyfjes and von Koenigswald then published scientific papers stating that the skull was unearthed 1m deep from a hill-slope outcrop of conglomeratic sandstone in Duyfjes' Pucangan formation. A cross section by Andoyo, which may show the Mojokerto site, also indicates a skull at 1m depth in conglomeratic sandstone. Photographs taken in 1936-1938 show a shallow pit at a single field location that fits Duyfjes' site description and is identified as the Mojokerto-skull site in 1940-1943 publications. By WWII the scientific community accepted the skull as an early hominid. Although von Koenigswald's "surface-find" comment remains a source of doubt in the record, we consider in situ discovery for the
Piron, A; Roch, J B
The hominisation of the skull comes with the bipedic posture, due to a network of muscular and aponevrotic forces applied to the cranio-facial skeleton. A brief sight of the morphogenetic origine and issues of these forces help to understand more clearly the postural statement of the larynx, his functions, and his many extrinsic biomechanical bounds; then further his most frequently dysfunctions. The larynx is surrounded by several effective systems of protection: active, activo-passive, passive. The architectural features of the components of the laryngeal system allows us to consider the laryngeal function as an auto-balanced system. All the forces engaged are auto-balanced in a continuum of tension. This lead us to the concept of tensegrity system, neologism coming from tensional integrity described by Buckminster Fuller. The laryngeal employement by extrinsic system is pathological in case of chronicity. Any osteopathic treatment, which aims to restore the losses of laryngeal mobility, has to release first the peripherical structures involved in the laryngeal defense, before normalising the larynx itself Finally, the larynx recovers his functions in a tensegrity system.
Daza, Juan D; Mapps, Aurelia A; Lewis, Patrick J; Thies, Monte L; Bauer, Aaron M
Traditionally, geckos have been conceived to exhibit paedomorphic features relative to other lizards (e.g., large eyes, less extensively ossified skulls, and amphicoelous and notochordal vertebrae). In contrast, peramorphosis has not been considered an important process in shaping their morphology. Here, we studied different sized specimens of Gekko gecko to document ontogenetic changes in cranial anatomy, especially near maturity. Comparison of this species with available descriptions of other geckos resulted in the identification of 14 cranial characteristics that are expressed more strongly with size increase. These characteristics become move evident in later stages of post-hatching development, especially near maturation, and are, therefore, attributed to peramorphosis (hyperossification). ACCTRAN and DELTRAN character optimizations were applied to these characters using a tree of 11 genera derived from a gekkotan molecular phylogeny. This analysis revealed that G. gecko expresses the majority of these putative peramorphic features near maturity, and that some of these features are also expressed in species closely related to G. gecko. The characters studied have the potential to be applied in future phylogenetic and taxonomic studies of this group of lizards.
Klepáček, Ivo; Malá, Pavla Zedníková
The objective of this study was to create a real model of a face using the well preserved "Bochdalek's skull" (from an eighteenth Century female aged 18 years) kept in the museum of anatomy (Institute of Anatomy, 1st Medical Faculty, Charles University in Prague). The skull had previously been appraised as a deformed skull with an adhesion present on both sides of the jaw, most likely of post-traumatic origin (bilateral syngnathia). In an attempt to find the best description for it, and to identify the spatial relationships between the surface of the facial bones which had changed in shape, as well as the formation of soft tissue on the face, we decided to perform a 3D reconstruction of the face. Due to the necessity of preserving the unique original undamaged skull, we created an exact digital "casting" of the facial bone structure on a computer first, which we then converted into a three-dimensional model using a 3D RepRap printer. We needed to take into consideration the fact that we had no portrait of the girl, just the skull. For this reason, we opted for a selected combination of anthropologic steps (the modified Manchester technique), which in our view, allows for optimum creation of the topography of the face in keeping with the deformed skull. The resulting reconstructed face was old in appearance with an overhanging lower lip and flattened surfaces in the areas of the temporalis and masseter muscles.
Martínez-Abadías, Neus; Esparza, Mireia; Sjøvold, Torstein; González-José, Rolando; Santos, Mauro; Hernández, Miquel; Klingenberg, Christian Peter
It has long been unclear whether the different derived cranial traits of modern humans evolved independently in response to separate selection pressures or whether they resulted from the inherent morphological integration throughout the skull. In a novel approach to this issue, we combine evolutionary quantitative genetics and geometric morphometrics to analyze genetic and phenotypic integration in human skull shape. We measured human skulls in the ossuary of Hallstatt (Austria), which offer a unique opportunity because they are associated with genealogical data. Our results indicate pronounced covariation of traits throughout the skull. Separate simulations of selection for localized shape changes corresponding to some of the principal derived characters of modern human skulls produced outcomes that were similar to each other and involved a joint response in all of these traits. The data for both genetic and phenotypic shape variation were not consistent with the hypothesis that the face, cranial base, and cranial vault are completely independent modules but relatively strongly integrated structures. These results indicate pervasive integration in the human skull and suggest a reinterpretation of the selective scenario for human evolution where the origin of any one of the derived characters may have facilitated the evolution of the others.
Santoro, Valeria; Lubelli, Sergio; De Donno, Antonio; Inchingolo, Alessio; Lavecchia, Fulvio; Introna, Francesco
The identification of bodies through the examination of skeletal remains holds a prominent place in the field of forensic investigations. Technological advancements in 3D facial acquisition techniques have led to the proposal of a new body identification technique that involves a combination of craniofacial superimposition and photogrammetry. The aim of this study was to test the method by superimposing various computerized 3D images of skulls onto various photographs of missing people taken while they were still alive in cases when there was a suspicion that the skulls in question belonged to them. The technique is divided into four phases: preparatory phase, 3d acquisition phase, superimposition phase, and metric image analysis 3d. The actual superimposition of the images was carried out in the fourth step. and was done so by comparing the skull images with the selected photos. Using a specific software, the two images (i.e. the 3D avatar and the photo of the missing person) were superimposed. Cross-comparisons of 5 skulls discovered in a mass grave, and of 2 skulls retrieved in the crawlspace of a house were performed. The morphologyc phase reveals a full overlap between skulls and photos of disappeared persons. Metric phase reveals that correlation coefficients of this values, higher than 0.998-0,997 allow to confirm identification hypothesis.
Markworth, Kimberly A.
Design research methodology is used in this study to develop an empirically-substantiated instruction theory about students' development of functional thinking in the context of geometric growing patterns. The two research questions are: (1) How does students' functional thinking develop in the context of geometric growing patterns? (2) What are…
Gerrits, Peter O; Veening, Jan G
What can be learned from historical anatomical drawings and how to incorporate these drawings into anatomical teaching? The drawing "A skull sectioned" (RL 19058v) by Leonardo da Vinci (1452-1519), hides more detailed information than reported earlier. A well-chosen section cut explores sectioned paranasal sinuses and ductus nasolacrimalis. A dissected lateral wall of the maxilla is also present. Furthermore, at the level of the foramen mentale, the drawing displays compact and spongious bony components, together with a cross-section through the foramen mentale and its connection with the canalis mandibulae. Leonardo was the first to describe a correct dental formula (6424) and made efforts to place this formula above the related dental elements. However, taking into account, the morphological features of the individual elements of the maxilla, it can be suggested that Leonardo sketched a "peculiar dental element" on the position of the right maxillary premolar in the dental sketch. The fact that the author did not make any comment on that special element is remarkable. Leonardo could have had sufficient knowledge of the precise morphology of maxillary and mandibular premolars, since the author depicted these elements in the dissected skull. The fact that the author also had access to premolars in situ corroborates our suggestion that "something went wrong" in this part of the drawing. The present study shows that historical anatomical drawings are very useful for interactive learning of detailed anatomy for students in medicine and dentistry.
Bello, Silvia M.; Parfitt, Simon A.; Stringer, Chris B.
Background The use of human braincases as drinking cups and containers has extensive historic and ethnographic documentation, but archaeological examples are extremely rare. In the Upper Palaeolithic of western Europe, cut-marked and broken human bones are widespread in the Magdalenian (∼15 to 12,000 years BP) and skull-cup preparation is an element of this tradition. Principal Findings Here we describe the post-mortem processing of human heads at the Upper Palaeolithic site of Gough's Cave (Somerset, England) and identify a range of modifications associated with the production of skull-cups. New analyses of human remains from Gough's Cave demonstrate the skilled post-mortem manipulation of human bodies. Results of the research suggest the processing of cadavers for the consumption of body tissues (bone marrow), accompanied by meticulous shaping of cranial vaults. The distribution of cut-marks and percussion features indicates that the skulls were scrupulously 'cleaned' of any soft tissues, and subsequently modified by controlled removal of the facial region and breakage of the cranial base along a sub-horizontal plane. The vaults were also ‘retouched’, possibly to make the broken edges more regular. This manipulation suggests the shaping of skulls to produce skull-cups. Conclusions Three skull-cups have been identified amongst the human bones from Gough's Cave. New ultrafiltered radiocarbon determinations provide direct dates of about 14,700 cal BP, making these the oldest directly dated skull-cups and the only examples known from the British Isles. PMID:21359211
Stayton, C Tristan
Patterns of diversity among lizard skulls were studied from a morphological, phylogenetic, and functional perspective. A sample of 1,030 lizard skulls from 441 species in 17 families was used to create a lizard skull morphospace. This morphospace was combined with a phylogeny of lizard families to summarize general trends in the evolution of the lizard skull. A basal morphological split between the Iguania and Scleroglossa was observed. Iguanians are characterized by a short, high skull, with large areas of attachment for the external adductor musculature, relative to their sister group. The families of the Iguania appear to possess more intrafamilial morphological diversity than families of the Scleroglossa, but rarefaction of the data reveals this to be an artifact caused by the greater number of species represented in Iguanian families. Iguanian families also appear more dissimilar to one another than families of the Scleroglossa. Permutation tests indicate that this pattern is real and not due to the smaller number of families in the Iguanidae. Parallel and convergent evolution is observed among lizards with similar diets: ant and termite specialists, carnivores, and herbivores. However, these patterns are superimposed over the more general phylogenetic pattern of lizard skull diversity. This study has three central conclusions. Different clades of lizards show different patterns of disparity and divergence in patterns of morphospace occupation. Phylogeny imposes a primary signal upon which a secondary ecological signal is imprinted. Evolutionary patterns in skull metrics, taken with functional landmarks, allow testing of trends and the development of new hypotheses concerning both shape and biomechanics.
Ishii, Masuko; Yayama, Kazuhiro; Motani, Hisako; Sakuma, Ayaka; Yasjima, Daisuke; Hayakawa, Mutumi; Yamamoto, Seiji; Iwase, Hirotaro
Superimposition has been applied to skulls of unidentified skeletonized corpses as a personal identification method. The current method involves layering of a skull and a facial image of a suspected person and thus requires a real skeletonized skull. In this study, we scanned skulls of skeletonized corpses by computed tomography (CT), reconstructed three-dimensional (3D) images of skulls from the CT images, and superimposed the 3D images with facial images of the corresponding persons taken in their lives. Superimposition using 3D-reconstructed skull images demonstrated, as did superimposition using real skulls, an adequate degree of morphological consistency between the 3D-reconstructed skulls and persons in the facial images. Three-dimensional skull images reconstructed from CT images can be saved as data files and the use of these images in superimposition is effective for personal identification of unidentified bodies.
Tang, Chi; You, Fusheng; Cheng, Guang; Gao, Dakuan; Fu, Feng; Yang, Guosheng; Dong, Xiuzhen
A study on correlation between structure and resistivity variations was performed for live adult human skull. The resistivities of 388 skull samples, excised from 48 skull flaps of patients undergoing surgery, were measured at body temperature (36.5 degrees C) using the well-known four-electrode method in the frequency range of 1-4 MHz. According to different structures of the skull samples, all the 388 samples were classified into six categories and measured their resistivities: standard trilayer skull (7943 +/- 1752 ohm x cm, 58 samples), quasi-trilayer skull (14,471 +/- 3061 ohm x cm, 110 samples), standard compact skull (26,546 +/- 5374 ohm x cm, 62 samples), quasi-compact skull (19,824 +/- 3232 ohm x cm, 53 samples), dentate suture skull (5782 +/- 1778 ohm x cm, 41 samples), and squamous suture skull (12747 +/- 4120 ohm x cm, 64 samples). The results showed that the skull resistivities were not homogenous and were significantly influenced by local structural variations. The presence of sutures appeared to decrease the overall resistivity of particular regions largely and dentate suture decreased the resistivity more than squamous suture. The absence of diploe appeared to increase skull resistivity. The percentage on thickness of diploe would be the primary factor in determining the resistivity of the skull sample without suture. From resistivity spectra results, an inverse relationship between skull resistivity and signal frequency was found.
Denning, D W; Gill, S S
A woman developed meningitis due to Neisseria lactamica in association with a cribriform plate fracture. Cerebrospinal fluid antigen tests for Neisseria meningitidis were negative. The patient recovered with intravenous penicillin therapy. N. lactamica can be rapidly distinguished from N. meningitidis by the hydrolysis of ONPG (o-nitrophenyl-beta-D-galactopyranoside). In contrast to N. meningitidis and Neisseria gonorrhoeae, N. lactamica lacks virulence properties. As 100% of N. lactamica strains are susceptible to penicillin and all three previously described patients with N. lactamica meningitis have recovered with penicillin treatment, the reason for distinguishing the organisms in this context is primarily to prevent unnecessary anxiety and prophylaxis among contacts.
Arnold, Wolfgang H; Fedorischeva, Victoria A; Naumova, Ella A; Yabluchansky, Nikolay I
Standardized lateral cephalograms of eleven skulls with artificial cranial deformations from Eastern Europe and twenty normal skulls from the same population were made, digitized and imported into the AutoCAD 2005 computer program. The x- and y-coordinates of defined measuring points were determined and angle measurements were made. The form difference of the skulls was tested with the Euclidean Distance Matrix Analysis (EDMA) and the difference of the angle measurements were compared statistically using the non-parametric Mann-Whitney test. All deformed skulls belonged to the tabular fronto-occipital type of deformation. The results of the EDMA and the angle measurements indicated significant differences for the neurocranium and the facial cranium in height between the normal and the deformed skulls, but not in the cranial length. It can be concluded that in Eastern Europe one method of cranial molding was used. The deformation of the neurocranium also affected the development of the facial cranium regarding facial height. This may indicate a dependency of the developmental fields of the neurocranium and facial cranium.
Cavel, Oren; Abergel, Avraham; Margalit, Nevo; Fliss, Dan M.; Gil, Ziv
The objective of the study is to evaluate patients' quality of life (QOL) after endoscopic resection of skull base tumors. We estimated the QOL of 41 patients who underwent surgery for removal of skull base tumors via the expanded endonasal approach (EEA). The Anterior Skull Base Surgery Questionnaire (ASBS-Q), a multidimensional, disease-specific instrument containing 36 items was used. The rate of meningitis and cerebrospinal fluid leak was 1.4 and 0%, respectively. There was one case of uniocular visual impairment. The internal consistency of the instrument had a correlation coefficient (α-Cronbach score) of 0.8 to 0.92. Of 41 patients, 30 (75%) reported improvement or no change in overall QOL. Improved scores were reported in the physical function domain and worse scores in the specific symptoms domain. The most significant predictor of poor QOL was female gender, which led to a significant decrease in scores of all domains. Site of surgery, histology, age and comorbidity were not significant predictors of outcome. This paper further validates the use of the ASBS-Q for patients undergoing endoscopic skull base resection. The overall QOL of patients following endoscopic extirpation of skull base tumors is good. Female patients experience a significant decline in QOL compared with males. PMID:23542557
O'Malley, Bert W. Weinstein, Gregory S.
Purpose: To develop a minimally invasive surgical technique to access the midline and anterior skull base using the optical and technical advantages of robotic surgical instrumentation. Methods and Materials: Ten experimental procedures focusing on approaches to the nasopharynx, clivus, sphenoid, pituitary sella, and suprasellar regions were performed on one cadaver and one live mongrel dog. Both the cadaver and canine procedures were performed in an approved training facility using the da Vinci Surgical Robot. For the canine experiments, a transoral robotic surgery (TORS) approach was used, and for the cadaver a newly developed combined cervical-transoral robotic surgery (C-TORS) approach was investigated and compared with standard TORS. The ability to access and dissect tissues within the various areas of the midline and anterior skull base were evaluated, and techniques to enhance visualization and instrumentation were developed. Results: Standard TORS approaches did not provide adequate access to the midline and anterior skull base; however, the newly developed C-TORS approach was successful in providing the surgical access to these regions of the skull base. Conclusion: Robotic surgery is an exciting minimally invasive approach to the skull base that warrants continued preclinical investigation and development.
One thousand patients had both CT of the head and a conventional skull series of radiographs. Radiographic findings were abnormal in 250 patients (25%), but only 64 patients (6.4%) had diagnostically significant abnormalities at radiography that were not detected by CT. If the 163 patients who presented after acute trauma were excluded from the series, only 39 (4.7%) of the remaining patients had radiographically significant abnormal findings that were not seen at CT, and only two (0.2%) of these abnormalities could not be diagnosed by a lateral skull radiograph alone. In only five patients (0.5%) was the management actively changed because an abnormaltiy that was detected at skull radiography was not detected at CT. Thus, in nontrauma patients who have stroke, epilepsy, dementia, or non-specific symptoms without focal signs, or have recently undergone craniotomy, and who have been referred for CT, skull radiographs are not justified. In the patient with a history and findings that are strongly suggestive of a pathological disorder anywhere other than in the sella turcica, cerebello-pontine angle, and paranasal sinuses, only the lateral skull radiograph should be obtained after CT, and only if CT is equivocal.
Spradley, M Katherine; Jantz, Richard L
When the pelvis is unavailable, the skull is widely considered the second best indicator of sex. The goals of this research are to provide an objective hierarchy of sexing effectiveness of cranial and postcranial elements and to test the widespread notion that the skull is superior to postcranial bones. We constructed both univariate and multivariate discriminant models using data from the Forensic Anthropology Data Bank. Discriminating effectiveness was assessed by cross-validated classification, and in the case of multivariate models, Mahalanobis D(2). The results clearly indicate that most postcranial elements outperform the skull in estimating sex. It is possible to correctly sex 88-90% of individuals with joint size, up to 94% with multivariate models of the postcranial bones. The best models for the cranium do not exceed 90%. We conclude that postcranial elements are to be preferred to the cranium for estimating sex when the pelvis is unavailable.
Tejszerska, Dagmara; Wolański, Wojciech; Larysz, Dawid; Gzik, Marek; Sacha, Edyta
Craniosynostosis represents premature suture fusion of the fetal and neonatal skull. Pathogenesis of craniosynostosis is complex and probably multifactorial. Growth of skull bones is strictly connected with the expanding growth of the brain and cranial malformations or prematurely fused sutures cause abnormal head shape. In order to diagnose the craniosynostosis, physical examination, plain radiography, and computed tomography with 3D reconstructions are indispensable. Engineering software such as Mimics v.13.1 and 3-matic v.5.0 enables a 3-dimensional model of head to be generated, based on the pictures obtained from CT. It is also possible to indicate the distances between the characteristic anatomical points. These measures are helpful during planning the neurosurgical correction of the skull, because the possibility of strictly specifing incisions before surgery, which is very important to provide the maximal safety of a child.
Alam, Parvez; Amini, Shahrouz; Tadayon, Maryam; Miserez, Ali; Chinsamy, Anusuya
The sperm whale skull amphitheatre cradles an enormous two-tonne spermaceti organ. The amphitheatre separates this organ from the cranium and the cervical vertebrae that lie in close proximity to the base of the skull. Here, we elucidate that this skull amphitheatre is an elastic, flexible, triple-layered structure with mechanical properties that are conjointly guided by bone histology and the characteristics of pore space. We contend that the amphitheatre will flex elastically to equilibrate forces transmitted via the spermaceti organ that arise through diving. We find that collisions from sperm whale aggression do not cause the amphitheatre to bend, but rather localise stress to the base of the amphitheatre on its anterior face. We consider, therefore, that the uniquely thin and extended construction of the amphitheatre, has relevance as an energy absorptive structure in diving.
Sa, Jason K.; Lee, In-Hee; Hong, Sang Duk; Kong, Doo-Sik; Nam, Do-Hyun
Skull base chordoma is a primary rare malignant bone-origin tumor showing relatively slow growth pattern and locally destructive lesions, which can only be characterized by histologic components. There is no available prognostic or therapeutic biomarker to predict clinical outcome or treatment response and the molecular mechanisms underlying chordoma development still remain unexplored. Therefore, we sought out to identify novel somatic variations that are associated with chordoma progression and potentially employed as therapeutic targets. Thirteen skull base chordomas were subjected for whole-exome and/or whole-transcriptome sequencing. In process, we have identified chromosomal aberration in 1p, 7, 10, 13 and 17q, high frequency of functional germline SNP of the T gene, rs2305089 (P = 0.0038) and several recurrent alterations including MUC4, NBPF1, NPIPB15 mutations and novel gene fusion of SAMD5-SASH1 for the first time in skull base chordoma. PMID:27901492
North, S.; Pollak, E.W.
The role of skull roentgenograms in determining choice of therapy, hospital admission, and length of hospitalization was evaluated in 106 consecutive patients with head injury. Thirty patients were discharged from the emergency room after initial evaluation and had uneventful recovery. Seventy-six were admitted and discharged without operative treatment one to ten days later. Only five had pathologic skull findings roentgenographicaly. Of these, one was discharged from the emergency department; the remaining four were admitted because of abnormal neurologic findings. All five recovered uneventfully. Another patient who had a normal roentgenographic evaluation required subsequent admission for craniotomy. Skull roentgenograms were an unimportant factor in the management of head injury patients and did not eliminate the need for complete and serial neurologic evaluation.
Lau, Stephan; Güllmar, Daniel; Flemming, Lars; Grayden, David B; Cook, Mark J; Wolters, Carsten H; Haueisen, Jens
Magnetoencephalography (MEG) signals are influenced by skull defects. However, there is a lack of evidence of this influence during source reconstruction. Our objectives are to characterize errors in source reconstruction from MEG signals due to ignoring skull defects and to assess the ability of an exact finite element head model to eliminate such errors. A detailed finite element model of the head of a rabbit used in a physical experiment was constructed from magnetic resonance and co-registered computer tomography imaging that differentiated nine tissue types. Sources of the MEG measurements above intact skull and above skull defects respectively were reconstructed using a finite element model with the intact skull and one incorporating the skull defects. The forward simulation of the MEG signals reproduced the experimentally observed characteristic magnitude and topography changes due to skull defects. Sources reconstructed from measured MEG signals above intact skull matched the known physical locations and orientations. Ignoring skull defects in the head model during reconstruction displaced sources under a skull defect away from that defect. Sources next to a defect were reoriented. When skull defects, with their physical conductivity, were incorporated in the head model, the location and orientation errors were mostly eliminated. The conductivity of the skull defect material non-uniformly modulated the influence on MEG signals. We propose concrete guidelines for taking into account conducting skull defects during MEG coil placement and modeling. Exact finite element head models can improve localization of brain function, specifically after surgery.
Lau, Stephan; Güllmar, Daniel; Flemming, Lars; Grayden, David B.; Cook, Mark J.; Wolters, Carsten H.; Haueisen, Jens
Magnetoencephalography (MEG) signals are influenced by skull defects. However, there is a lack of evidence of this influence during source reconstruction. Our objectives are to characterize errors in source reconstruction from MEG signals due to ignoring skull defects and to assess the ability of an exact finite element head model to eliminate such errors. A detailed finite element model of the head of a rabbit used in a physical experiment was constructed from magnetic resonance and co-registered computer tomography imaging that differentiated nine tissue types. Sources of the MEG measurements above intact skull and above skull defects respectively were reconstructed using a finite element model with the intact skull and one incorporating the skull defects. The forward simulation of the MEG signals reproduced the experimentally observed characteristic magnitude and topography changes due to skull defects. Sources reconstructed from measured MEG signals above intact skull matched the known physical locations and orientations. Ignoring skull defects in the head model during reconstruction displaced sources under a skull defect away from that defect. Sources next to a defect were reoriented. When skull defects, with their physical conductivity, were incorporated in the head model, the location and orientation errors were mostly eliminated. The conductivity of the skull defect material non-uniformly modulated the influence on MEG signals. We propose concrete guidelines for taking into account conducting skull defects during MEG coil placement and modeling. Exact finite element head models can improve localization of brain function, specifically after surgery. PMID:27092044
Joo, Mee; Lee, Ghi Jai; Koh, Young-Cho; Kwon, O-Ki; Park, Yong-Koo
Malignant fibrous histiocytoma (MFH) is a rare primary neoplasm that constitutes less than 1% of the malignant tumors of bone, and involvement of the skull is very rare. We present a case of malignant fibrous histiocytoma of the skull, presenting an intraosseous lesion in a 43-yr-old woman. She had a rapidly growing, tender mass in the right parietal region. A plain radiograph showed an osteolytic lesion of the right parietal bone. Magnetic resonance imaging revealed that the lesion showed heterogeneous low signal intensity on T1-weighted images and slightly high signal intensity on T2-weighted images. No evidence of an extraosseous extension to the adjacent dura and soft tissue was found, and a wide excision of the parietal bone was performed. Histologically, the tumor was a typical MFH displaying pleomorphic spindle cells in a storiform pattern. The results of immunohistochemical stainings revealed that the tumor cells were positive for vimentin, alpha-1-antitrypsin, and p53, and negative for smooth muscle actin, S100 protein, desmin, and MyoD1. Three months later, a mainly cystic, recurrent mass was developed at the previously operated site. Before the resection, we first performed the percutaneous aspiration cytology, revealing diagnostic multinucleated pleomorphic cells. Thereafter, she had to receive repetitive resections of recurrent or residual lesions, and she died of postoperative meningoencephalitis two years after the first operation. PMID:12923345
Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture ... Some ankle fractures may require surgery when: The ends of the bone are out of line with each other (displaced). The ...
Goldenberg, D; Karam, M; Danino, J; Flax-Goldenberg, R; Joachims, H Z
Blunt trauma to the temporal region can cause fracture of the skull base, loss of hearing, vestibular symptoms and otorrhoea. The most common causes of blunt trauma to the ear and surrounding area are motor vehicle accidents, violent encounters, and sports-related accidents. We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.
Sigler, Aaron C; D'Anza, Brian; Lobo, Brian C; Woodard, Troy; Recinos, Pablo F; Sindwani, Raj
Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient.
Santini, L; Varoquaux, A; Giovanni, A; Dessi, P; Michel, J
Recurrent ameloblastoma with skull base invasion is a rare clinical entity with poor prognosis. We report a case of a mandibular ameloblastoma recurrence involving the anterior skull base. The diagnostic and therapeutic processes are presented with emphasis on the radiologic features of ameloblastoma. Another aim of this case report is to underline the importance of close and long-term follow-up after resection. Ameloblastoma recurrences are frequent and mainly occur after incomplete surgical resection. These recurrences may be diagnosed late because of lack of symptoms in the mandibular area.
Kasfiki, Eirini Vasileiou; Kelly, Ciaran; Smith, John; Nicolaides, Andreas
This is the first case of skull base osteomyelitis presenting with isolated bilateral hypoglossal nerve palsy reported in the literature. A 75-year-old man presented with tongue paralysis without any other cranial nerve palsy. He was otherwise well apart from recently having a high prostate-specific antigen level recorded. Investigations for malignancy or cerebrovascular insult were negative with the diagnosis of skull base osteomyelitis confirmed using CT. Following treatment with intravenous antibiotics for 6 weeks, symptoms resolved. PMID:23853016
Noel, Georges; Gondi, Vinai
Relative to conventional photon irradiation, proton therapy has distinct advantages in its ability to more precisely target tumor while shielding adjacent normal tissues. In the setting of skull base tumors, proton therapy plays a critical role in the dose-escalation required for optimal tumor control of chordomas, chondrosarcomas, and malignancies of the paranasal sinuses and nasal cavity. For benign tumors such as craniopharyngiomas, pituitary adenomas and meningiomas, proton therapy can limit long-term adverse effects, such as secondary malignancies. This review summarizes published literature to date regarding the role of proton therapy in skull base tumors and introduces emerging proton therapy approaches such as pencil-beam scanning (PBS).
Issara, K; Yossi, S; Caraivan, I
Primitive lymphomas of the bone are exceptional tumors, representing 4% of all non-Hodgkin lymphomas. The location at the skull remains the rarest. We report the case of a 56 year old patient with lytic lesions in the skull of a small cell lymphoma B, treated with primary chemotherapy and intensity-modulated radiotherapy in arctherapy with a dose of 30Gy in 15 fractions. With a follow-up time of 18 months after the end of treatment, the patient has no sign of disease evolution.
Salyer, K E; Gendler, E; Squier, C A
The successful use of cortical demineralized perforated bone in the treatment of extensive skeletal defects in children is exemplified by this case involving Siamese twins joined at the skull vertex. Four years following extensive skull reconstruction using demineralized perforated bone, an examination revealed successful calvarial reconstruction in one twin. The other twin required additional implants of demineralized perforated bone to fill in defects. However, a histologic examination taken following this additional procedure revealed that these implants neither caused tissue reaction over a 4-year period, nor showed signs of resorption. Bony remodeling and new bone formation were in progress. Compared with other bone substitutes, demineralized perforated bone has proven to be effective in the treatment of large skull defects in children.
Wan, Weibing; Shi, Pengfei; Li, Shuguang
Given the potential demonstrated by research into bone-tissue engineering, the use of medical image data for the rapid prototyping (RP) of scaffolds is a subject worthy of research. Computer-aided design and manufacture and medical imaging have created new possibilities for RP. Accurate and efficient design and fabrication of anatomic models is critical to these applications. We explore the application of RP computational methods to the repair of a pediatric skull defect. The focus of this study is the segmentation of the defect region seen in computerized tomography (CT) slice images of this patient's skull and the three-dimensional (3-D) surface rendering of the patient's CT-scan data. We see if our segmentation and surface rendering software can improve the generation of an implant model to fill a skull defect.
Nieman, Brian J; Blank, Marissa C; Roman, Brian B; Henkelman, R Mark; Millen, Kathleen J
The mammalian brain and skull develop concurrently in a coordinated manner, consistently producing a brain and skull that fit tightly together. It is common that abnormalities in one are associated with related abnormalities in the other. However, this is not always the case. A complete characterization of the relationship between brain and skull phenotypes is necessary to understand the mechanisms that cause them to be coordinated or divergent and to provide perspective on the potential diagnostic or prognostic significance of brain and skull phenotypes. We demonstrate the combined use of magnetic resonance imaging and microcomputed tomography for analysis of brain and skull phenotypes in the mouse. Co-registration of brain and skull images allows comparison of the relationship between phenotypes in the brain and those in the skull. We observe a close fit between the brain and skull of two genetic mouse models that both show abnormal brain and skull phenotypes. Application of these three-dimensional image analyses in a broader range of mouse mutants will provide a map of the relationships between brain and skull phenotypes generally and allow characterization of patterns of similarities and differences.
Germanovich, L. N.; Garagash, D.; Murdoch, L. C.; Robinowitz, M.
This study is motived by a new method for disposing of nuclear waste by injecting it as a dense slurry into a hydraulic fracture that grows downward to great enough depth to permanently isolate the waste. Disposing of nuclear waste using gravity-driven hydraulic fractures is mechanically similar to the upward growth of dikes filled with low density magma. A fundamental question in both applications is how the injected fluid controls the propagation dynamics and fracture geometry (depth and breadth) in three dimensions. Analog experiments in gelatin [e.g., Heimpel and Olson, 1994; Taisne and Tait, 2009] show that fracture breadth (the short horizontal dimension) remains nearly stationary when the process in the fracture "head" (where breadth is controlled) is dominated by solid toughness, whereas viscous fluid dissipation is dominant in the fracture tail. We model propagation of the resulting gravity-driven (buoyant or sinking), finger-like fracture of stationary breadth with slowly varying opening along the crack length. The elastic response to fluid loading in a horizontal cross-section is local and can be treated similar to the classical Perkins-Kern-Nordgren (PKN) model of hydraulic fracturing. The propagation condition for a finger-like crack is based on balancing the global energy release rate due to a unit crack extension with the rock fracture toughness. It allows us to relate the net fluid pressure at the tip to the fracture breadth and rock toughness. Unlike the PKN fracture, where breadth is known a priori, the final breadth of a finger-like fracture is a result of processes in the fracture head. Because the head is much more open than the tail, viscous pressure drop in the head can be neglected leading to a 3D analog of Weertman's hydrostatic pulse. This requires relaxing the local elasticity assumption of the PKN model in the fracture head. As a result, we resolve the breadth, and then match the viscosity-dominated tail with the 3-D, toughness
The felid family consists of two major subgroups, the sabretoothed and the feline cats, to which all extant species belong, and are the most anatomically derived of all carnivores for predation on large prey with a precision killing bite. There has been much controversy and uncertainty about why the skulls and mandibles of sabretoothed and feline cats evolved to become so anatomically divergent, but previous models have focused on single characters and no unifying hypothesis of evolutionary shape changes has been formulated. Here I show that the shape of the skull and mandible in derived sabrecats occupy entirely different positions within overall morphospace from feline cats, and that the evolution of skull and mandible shape has followed very different paths in the two subgroups. When normalised for body-size differences, evolution of bite forces differ markedly in the two groups, and are much lower in derived sabrecats, and they show a significant relationship with size and cranial shape, whereas no such relationship is present in feline cats. Evolution of skull and mandible shape in modern cats has been governed by the need for uniform powerful biting irrespective of body size, whereas in sabrecats, shape evolution was governed by selective pressures for efficient predation with hypertrophied upper canines at high gape angles, and bite forces were secondary and became progressively weaker during sabrecat evolution. The current study emphasises combinations of new techniques for morphological shape analysis and biomechanical studies to formulate evolutionary hypotheses for difficult groups. PMID:18665225
Meyer, Joel R.; Roychowdhury, Sudipta; Cybulski, George; Russell, Eric J.
The authors present an unusual case of solitary intramedullary plasmacytoma. Awareness of this entity can facilitate appropriate surgical planning, which may include a limited biopsy prior to considering more extensive skull base surgery. ImagesFigure 1Figure 2Figure 3 PMID:17170997
The felid family consists of two major subgroups, the sabretoothed and the feline cats, to which all extant species belong, and are the most anatomically derived of all carnivores for predation on large prey with a precision killing bite. There has been much controversy and uncertainty about why the skulls and mandibles of sabretoothed and feline cats evolved to become so anatomically divergent, but previous models have focused on single characters and no unifying hypothesis of evolutionary shape changes has been formulated. Here I show that the shape of the skull and mandible in derived sabrecats occupy entirely different positions within overall morphospace from feline cats, and that the evolution of skull and mandible shape has followed very different paths in the two subgroups. When normalised for body-size differences, evolution of bite forces differ markedly in the two groups, and are much lower in derived sabrecats, and they show a significant relationship with size and cranial shape, whereas no such relationship is present in feline cats. Evolution of skull and mandible shape in modern cats has been governed by the need for uniform powerful biting irrespective of body size, whereas in sabrecats, shape evolution was governed by selective pressures for efficient predation with hypertrophied upper canines at high gape angles, and bite forces were secondary and became progressively weaker during sabrecat evolution. The current study emphasises combinations of new techniques for morphological shape analysis and biomechanical studies to formulate evolutionary hypotheses for difficult groups.
Hardesty, Douglas A; Ponce, Francisco A; Little, Andrew S; Nakaji, Peter
Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials.
Deary, Ian J.; Ferguson, Karen J.; Bastin, Mark E.; Barrow, Geoffrey W. S.; Reid, Louise M.; Seckl, Jonathan R.; Wardlaw, Joanna M.; MacLullich, Alasdair M. J.
An estimate of someone's IQ is a potentially informative personal datum. This study examines the association between external skull measurements and IQ scores, and uses the resulting regression equation to provide an estimate of the IQ of King Robert I of Scotland (Robert Bruce, 1274-1329). Participants were 48 relatively healthy Caucasian men…
Serlin, Yonatan; Benifla, Mony; Kesler, Anat; Cohen, Avi; Shelef, Ilan
We report and discuss five patients with intracranial hypertension due to a skull lesion reducing cerebral sinus patency with a compressive, non-thrombotic mechanism. We illustrate the importance of a high level of suspicion for this condition in patients presenting with headache, papilledema and increased intracranial pressure in the absence of focal signs or radiological evidence of mass effect.
Reinard, Kevin; Basheer, Azam; Jones, Lamont; Standring, Robert; Lee, Ian; Rock, Jack
Background: Modern microsurgical techniques enable en bloc resection of complex skull base tumors. Anterior cranial base surgery, particularly, has been associated with a high rate of postoperative cerebrospinal fluid (CSF) leak, meningitis, intracranial abscess, and pneumocephalus. We introduce simple modifications to already existing surgical strategies designed to minimize the incidence of postoperative CSF leak and associated morbidity and mortality. Methods: Medical records from 1995 to 2013 were reviewed in accordance with the Institutional Review Board. We identified 21 patients who underwent operations for repair of large anterior skull base defects following removal of sinonasal or intracranial pathology using standard craniofacial procedures. Patient charts were screened for CSF leak, meningitis, or intracranial abscess formation. Results: A total of 15 male and 6 female patients with an age range of 26–89 years were included. All patients were managed with the same operative technique for reconstruction of the frontal dura and skull base defect. Spinal drainage was used intraoperatively in all cases but the lumbar drain was removed at the end of each case in all patients. Only one patient required re-operation for repair of persistent CSF leak. None of the patients developed meningitis or intracranial abscess. There were no perioperative mortalities. Median follow-up was 10 months. Conclusion: The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons. PMID:25722926
Hardesty, Douglas A.; Ponce, Francisco A.; Little, Andrew S.; Nakaji, Peter
Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials. PMID:26949585
following differential diagnosis: liquified hematoma , seroma, abscess, or proteinaceous fluid collection. Since the cultures were negative for bacteria...liquified hematoma was the working diagnosis. After surgical removal of skull cap from abdomen, it was decided to use prosthetic cranioplasty...most frequent principle diagnosis in patients receiving such surgeries is subdural hemorrhage.4 Recent studies demonstrate efficacy of banked bone
... to hold the fracture in the correct position. • Fiberglass casting is lighter and stronger and the exterior ... with your physician if this occurs. • When a fiberglass cast is used in conjunction with a GORE- ...
... make older people more likely to trip and fall — one of the most common causes of hip ... Taking steps to maintain bone density and avoid falls can help prevent hip fracture. Signs and symptoms ...
Hinkley, J. A.; Mings, S. L.
Two aromatic polyimides and an aromatic polyamide-imide were tested in single edge notched tension. Fracture toughnesses, normalized to 25 micron film thickness ranged from 1.65 to 5.4 MPa m sup 1/2. LARC-TPI, a thermoplastic polyimide, showed evidence of crazing ahead of a growing crack whereas the other materials formed a shear yielded zone.
Wright, Amanda; Gerhart, Ann E
Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.
Altizer, Linda L
Many people "slip and fall", especially in the icy areas of the winter season. To prevent an injury to the head, most people put their hand out to hit the ground first, so the wrist usually gets injured. The most frequent injury from this type of "intervention" is a fracture to the distal radius and/or ulna, which is frequently called a "Colles' fracture."
Boxer's fracture is a common name for a fracture of the distal fifth metacarpal and received its name from one of its most common causes, punching an object with a closed fist. It can occur from a fistfight or from punching a hard object. The injury of a "Boxer's Fracture" earned the name from the way in which the injury occurred, punching an immovable object with a closed fist and no boxing mitt (Figure 1). Naturally, a "Boxer" usually punches his fist into his opponent's face or body. An angry person may perform the same action into a person, or into the wall. The third person may be performing a task and strike something with his fist with forceful action accidentally. In any event, if the closed fist "punches" into an immovable or firm object with force, the most frequent injury sustained would be a fracture of the fifth metacarpal neck. Some caregivers would also call a fourth metacarpal neck fracture a boxer's fracture.
Delannoy, Y; Colard, T; Becart, A; Tournel, G; Gosset, D; Hedouin, V
Lesions of the cranial vault resulting from firearms are traditionally described in forensic medical literature with many reports illustrating atypical bone lesions carried out to the skull by gunshot wounds. The authors present this report which illustrates an external beveled skull wound, associated with internal beveling damage, caused by a stabbing injury. A partially buried human skeleton was found in a forest. The examining of the skull revealed a hole resembling the exit wound caused by a bullet and two other smaller stab wounds. No typical entering bullet wound and no other bone lesions were found. During the course of the investigation, one of the perpetrators admitted to hitting the victim, using a sickle, and to hiding the body. For this purpose, he dragged the corpse with the sickle still implanted in the skull, using it as a hook. Upon retrieving the sickle, a piece of cranial vault was removed, thus creating an external beveled wound. In order to identify the mechanism which brought about this kind of lesion, experimental work was carried out on a human skull. In this particular case, the tip of the sickle penetrated into the bone, creating a lesion that would typically be produced with a stabbing instrument when applied with vertical force. When the body was dragged, using the sickle as a hook, this was a hand-produced vertical force, which was applied in the opposite direction. It caused the tearing of a piece of bone and the creation of an outer bevel. This atypical lesion should be made known to medical examiners and pathologists in order to help investigating and understanding of the circumstances of injuries.
Benson, Roger B. J.; Evans, Mark; Smith, Adam S.; Sassoon, Judyth; Moore-Faye, Scott; Ketchum, Hilary F.; Forrest, Richard
Pliosaurids were a long-lived and cosmopolitan group of marine predators that spanned 110 million years and occupied the upper tiers of marine ecosystems from the Middle Jurassic until the early Late Cretaceous. A well-preserved giant pliosaurid skull from the Late Jurassic Kimmeridge Clay Formation of Dorset, United Kingdom, represents a new species, Pliosaurus kevani. This specimen is described in detail, and the taxonomy and systematics of Late Jurassic pliosaurids is revised. We name two additional new species, Pliosaurus carpenteri and Pliosaurus westburyensis, based on previously described relatively complete, well-preserved remains. Most or all Late Jurassic pliosaurids represent a globally distributed monophyletic group (the genus Pliosaurus, excluding ‘Pliosaurus’ andrewsi). Despite its high species diversity, and geographically widespread, temporally extensive occurrence, Pliosaurus shows relatively less morphological and ecological variation than is seen in earlier, multi-genus pliosaurid assemblages such as that of the Middle Jurassic Oxford Clay Formation. It also shows less ecological variation than the pliosaurid-like Cretaceous clade Polycotylidae. Species of Pliosaurus had robust skulls, large body sizes (with skull lengths of 1.7–2.1 metres), and trihedral or subtrihedral teeth suggesting macropredaceous habits. Our data support a trend of decreasing length of the mandibular symphysis through Late Jurassic time, as previously suggested. This may be correlated with increasing adaptation to feeding on large prey. Maximum body size of pliosaurids increased from their first appearance in the Early Jurassic until the Early Cretaceous (skull lengths up to 2360 mm). However, some reduction occurred before their final extinction in the early Late Cretaceous (skull lengths up to 1750 mm). PMID:23741520
Hagstrum, Jonathon T.; Firestone, Richard B; West, Allen; Stefanka, Zsolt; Revay, Zsolt
We have discovered what appear to be micrometeorites imbedded in seven late Pleistocene Alaskan mammoth tusks and a Siberian bison skull. The micrometeorites apparently shattered on impact leaving 2 to 5 mm hemispherical debris patterns surrounded by carbonized rings. Multiple impacts are observed on only one side of the tusks and skull consistent with the micrometeorites having come from a single direction. The impact sites are strongly magnetic indicating significant iron content. We analyzed several imbedded micrometeorite fragments from both tusks and skull with laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) and X-ray fluorescence (XRF). These analyses confirm the high iron content and indicate compositions highly enriched in nickel and depleted in titanium, unlike any natural terrestrial sources. In addition, electron microprobe (EMP) analyses of a Fe-Ni sulfide grain (tusk 2) show it contains between 3 and 20 weight percent Ni. Prompt gamma-ray activation analysis (PGAA) of a particle extracted from the bison skull indicates ~;;0.4 mg of iron, in agreement with a micrometeorite ~;;1 mm in diameter. In addition, scanning electron microscope (SEM) images and XRF analyses of the skull show possible entry channels containing Fe-rich material. The majority of tusks (5/7) have a calibrated weighted mean 14C age of 32.9 +- 1.8 ka BP, which coincides with the onset of significant declines<36 ka ago in Beringian bison, horse, brown bear, and mammoth populations, as well as in mammoth genetic diversity. It appears likely that the impacts and population declines are related events, although their precise nature remains to be determined.
Ishii, Masuko; Saitoh, Hisako; Yasjima, Daisuke; Yohsuk, Makino; Sakuma, Ayaka; Yayama, Kazuhiro; Iwase, Hirotaro
We previously reported that superimposition of 3-dimensional (3D) images reconstructed from computed tomographic images of skeletonized skulls on photographs of the actual skulls afforded a match of skull contours, thereby demonstrating that superimposition of 3D-reconstructed images provides results identical to those obtained with actual skulls. The current superimposition procedure requires a skeletonized skull with mouth closed and thus is not applicable to personal identification using a skull with residual soft tissue or the mouth fixed open, such as those found in mummified or burned bodies. In this study, we scanned using computed tomography the skulls of mummified and immersed body with mandibles fixed open by residual soft tissue, created 3D-reconstructed skull images, which were digitally processed by computer software to close the mandible, and superimposed the images on antemortem facial photographs. The results demonstrated morphological consistency between the 3D-reconstructed skull images and facial photographs, indicating the applicability of the method to personal identification.
Jayaprakash, P T; Srinivasan, G J; Amravaneswaran, M G
Skull-photograph superimposition continues to be the most prevalent method employed for identifying a skull recovered in a criminal case as that belonging to a putative victim whose face photograph is available. The reliability of identification achieved has been shown to be 91%, indicating the possibility of a skull mismatching with a face photograph belonging to a person other than the actual deceased. This lack of reliability dampens the confidence of the expert and in turn confounds the mind of the judge. It has been shown that the variations in the shape of the facial organs are influenced by the corresponding variations in the skeletal elements of the facial skull. "Cranio-facial morphanalysis", a new anthroposcopic method proposed here for evaluating the shape correlations between a skull and a face photograph, when applied conjointly with skull-photograph superimposition is shown to increase the reliability in forensic skull identification.
Slater, G J; VAN Valkenburgh, B
Allometric patterns of skull-shape variation can have significant impacts on cranial mechanics and feeding performance, but have received little attention in previous studies. Here, we examine the impacts of allometric skull-shape variation on feeding capabilities in the cat family (Felidae) with linear morphometrics and finite element analysis. Our results reveal that relative bite force diminishes slightly with increasing skull size, and that the skulls of the smallest species undergo the least strain during biting. However, larger felids are able to produce greater gapes for a given angle of jaw opening, and they have overall stronger skulls. The two large felids in this study achieved increased cranial strength by increasing skull bone volume relative to surface area. Allometry of skull geometry in large felids reflects a trade-off between the need to increase gape to access larger prey while maintaining the ability to resist unpredictable loading when taking large, struggling prey.
Pernot, Mathieu; Aubry, Jean-Francois; Tanter, Mickael; Fink, Mathias
Ultrasound brain therapy is currently limited by the strong phase and amplitude aberrations induced by the heterogeneities of the skull. However the development of aberration correction techniques has made it possible to correct the beam distortion induced by the skull and to produce a sharp focus in the brain. Moreover, using the density of the skull bone that can be obtained with high-resolution CT scans, the corrections needed to produce this sharp focus can be calculated using ultrasound propagation models. We propose here a model for computing the temperature elevation in the skull during High Intensity Focused Ultrasound (HIFU) transcranial therapy. Based on CT scans, the wave propagation through the skull is computed with 3D finite differences wave propagation software. The acoustic simulation is combined with a 3D thermal diffusion code and the temperature elevation inside the skull is computed. Finally, the simulation is validated experimentally by measuring the temperature elevation in several locations of the skull.
Blitz, Ari Meir; Aygun, Nafi; Herzka, Daniel A; Ishii, Masaru; Gallia, Gary L
High-resolution 3D MRI of the skull base allows for a more detailed and accurate assessment of normal anatomic structures as well as the location and extent of skull base pathologies than has previously been possible. This article describes the techniques employed for high-resolution skull base MRI including pre- and post-contrast constructive interference in the steady state (CISS) imaging and their utility for evaluation of the many small structures of the skull base, focusing on those regions and concepts most pertinent to localization of cranial nerve palsies and in providing pre-operative guidance and post-operative assessment. The concept of skull base compartments as a means of conceptualizing the various layers of the skull base and their importance in assessment of masses of the skull base is discussed.
Morrow, Chris J; Noormohammadi, Amir H; O'Donnell, Chris J
Investigation of unexpected mortality in caged layer chickens led to the discovery of a consistent traumatic injury to the heads of affected hens. Initial post-mortem examination found linear skin lacerations and associated fractures in the dorsal cranium of all birds examined, and 5 to 10 mm deep trauma in the underlying brain tissue. Post-mortem multidetector computed tomography (CT) scanning of two affected birds demonstrated similar obliquely orientated, linear, depressed fractures of the skulls consistent with a single, severe impact force to the head. Both skull fractures had a pattern of rounded, rostral expansion measuring approximately 3 mm in width. On inspection of the cages during a farm visit, this CT pattern corresponded with the size and shape of sheet metal lugs holding feed troughs onto the cages (on which blood stains were subsequently observed). Based on this analysis and hypothesizing that hunger was a triggering factor, a recommendation was made to reverse the shed "lights on" and feed hopper operation times with instant reduction in mortality. This case highlights the value of post-mortem CT imaging in bird death investigation where trauma is a postulated cause.
Alajmi, A.; Gharbi, R.
Most hydrocarbon reservoirs are fractured in nature with various degrees of fracture intensities. With the current oil prices and growing demand for oil, a great interest is built in the petroleum industry to characterize partially fractured reservoirs and to develop an increased understanding of the physics of fluid flow in these types of reservoirs. This is due to the fact that fractured reservoirs have different performance behavior and high potential for oil recovery than conventional reservoirs. Therefore, prediction and understanding of fluid displacement in these reservoirs is very much critical in the decision on the applicability of oil recovery methods. Using a finite difference numerical simulator, this study investigated the effect of reservoir fracture intensities on the displacement behavior. Several heterogeneous permeable media, each with different probability of fracture intensity, were generated stochastically. The fracture intensity covers reservoirs with no fracture (zero fracture intensity) to fully fractured reservoirs (fracture intensity of 1). In order to better describe and model fractured reservoirs, a dual porosity-dual permeability model was built. Extensive simulations of water displacing oil were then performed in each of the generated fractured models for different well configurations. The objective was to determine the functional relationships between the displacement performance, fracture intensities, and well configurations. The study has resulted in significant new insights into the flow characterization in naturally fractured reservoirs. Results show that the reservoir fracture intensity has considerable effects on the efficiency of fluid displacement in naturally fractured reservoirs. A critical value of reservoir fracture intensity appears to sort favorable from unfavorable displacement, causing the displacement to be either fracture-dominated or matrix-dominated. The conditions under which fluid displacement may yield better
Bonneau, François; Henrion, Vincent; Caumon, Guillaume; Renard, Philippe; Sausse, Judith
Stochastic simulation of fracture systems is an interesting approach to build a set of dense and complex networks. However, discrete fracture models made of planar fractures generally fail to reproduce the complexity of natural networks, both in terms of geometry and connectivity. In this study a pseudo-genetic method is developed to generate stochastic fracture models that are consistent with patterns observed on outcrops and fracture growth principles. The main idea is to simulate evolving fracture networks through geometric proxies by iteratively growing 3D fractures. The algorithm defines heuristic rules in order to mimic the mechanics of fracture initiation, propagation, interaction and termination. The growth process enhances the production of linking structure and impacts the connectivity of fracture networks. A sensitivity study is performed on synthetic examples. The method produces unbiased fracture dip and strike statistics and qualitatively reproduces the fracture density map. The fracture length distribution law is underestimated because of the early stop in fracture growth after intersection.
Deng, Qingqiong; Zhou, Mingquan; Shui, Wuyang; Wu, Zhongke; Ji, Yuan; Bai, Ruyi
Craniofacial reconstruction is important in forensic identification. It aims to estimate a facial appearance for human skeletal remains using the relationship between the soft tissue and the underlying bone structure. Various computerized methods have been developed in recent decades. An effective way is to deform a reference skull to the discovered skull, and then apply the same deformation to the skin associated with the reference skull to provide an approximate face for the discovered skull. For this method, the better the two skulls match each other, the more face-like the reconstructed skin surface will be. In this paper, we present a novel skull registration method that can match the two skulls closely, so as to improve the accuracy of the reconstruction. It combines both global and local deformations. A generic thin-plate spline (TPS)-based deformation, which is global, is applied first to roughly align the two skulls based on two groups of manually defined landmarks. Afterwards, the two skulls are largely matched, except some regions, on which some new landmarks are automatically marked. A compact support radial basis functions (CSRBF)-based deformation, which is local, will then be performed on these regions to adjust the initial alignment of the two skulls. Such adjustment can be repeatedly implemented until the two skulls have optimal alignment. In addition, all the skulls and face involved in the registration are represented by their single outer surfaces to facilitate the reconstruction procedure. The experiments demonstrate that our method can create a plausible face even when the reference skull is very different from the discovered skull. As a result, we can make full use of our database to provide multiple estimates for a principle components analysis (PCA) for the final reconstruction.
Pirouzmand, Farhad; Muhajarine, Nazeem
The geometric configuration of the skull is complex and unique to each individual. This study provides a new technique to define the outline of skull profile and attempt to find the common factors defining the ultimate skull configuration in adult population. Ninety-three lateral skull x-ray from the computed tomographic scan films were selected and digitized. The lateral skull surface was divided into 3 regions based on the presumed location of the coronal and lambdoid sutures. Three main curvatures (frontal, parietal, occipital) were consistently identified to overlap the skull periphery. The radius, cord length, and inclination of each curvature were measured. The average values for 3 defined curvatures of the skull profile were recorded. Factor analysis of the measured values produced 3 factors explaining the skull profile. The first factor explained 32% of total variance and was related to the overall size of the head as represented by total length and the radius of the curvature in the vertex and back of the head. The second factor covered 26% of the variance representing the inverse correlation between the angle of the frontal and parietal curves. The third factor revealed the direct correlation of the occipital and parietal angle. In all of these factors, the frontal zone variation was independent or opposite of the parieto-occipital zone. A strong association between the total length of the skull, occipital curve radius, and length with the sex was shown. In conclusion, the skull profile topography has large variation and can be defined mathematically by 2 distinct territories: frontal and parieto-occipital zones. These territories hinge on the coronal suture. Therefore, the coronal suture may play a dominant role in final skull configuration.
... fracture which goes at an angle to the axis Comminuted - a fracture of many relatively small fragments Spiral - a fracture which runs around the axis of the bone Compound - a fracture (also called ...
This book contains papers on hydraulic fracturing. Topics covered include: An overview of recent advances in hydraulic fracturing technology; Containment of massive hydraulic fracture; and Fracturing with a high-strength proppant.
Lucke-Wold, Brandon P; Turner, Ryan C; Logsdon, Aric Flint; Rosen, Charles L; Qaiser, Rabia
Neurotrauma from blast exposure is one of the single most characteristic injuries of modern warfare. Understanding blast traumatic brain injury is critical for developing new treatment options for warfighters and civilians exposed to improvised explosive devices. Unfortunately, the pre-clinical models that are widely utilized to investigate blast exposure are based on archaic lung based parameters developed in the early 20th century. Improvised explosive devices produce a different type of injury paradigm than the typical mortar explosion. Protective equipment for the chest cavity has also improved over the past 100 years. In order to improve treatments, it is imperative to develop models that are based more on skull-based parameters. In this mini-review, we discuss the important anatomical and biochemical features necessary to develop a skull-based model. PMID:28386605
Daza, Juan D; Abdala, Virginia; Thomas, Richard; Bauer, Aaron M
A detailed description of the skull and jaw of the gecko Sphaerodactylus roosevelti is presented. The bones are described articulated and isolated with special consideration given to the type of suture among joining elements. S. roosevelti was compared with 109 gekkotan species to evaluate the osteological variation and to find characters for cladistic analysis. Changes in the skull associated with the miniaturization process are discussed within the sphaerodactylid geckos. A noticeable increase of overlapping sutures was observed in the snout of the smallest sphaerodactylids compared to other gekkotans. This pattern is convergent with that in miniaturized pygopodids and may be attributed to adaptations for decreasing mechanical resistance of the cranium during feeding or burrowing. New cranial characters support Sphaerodactylinae as a monophyletic group and should be useful for resolving questions such as their relationship with other gekkotans.
Gunawat, Prashant; Karmarkar, Vikram; Deopujari, Chandrashekhar; Shah, Nishit
Seizure is a classical feature of intra axial brain parenchymal lesion. Simple bone cyst is an unusual bony pathology at skull base presenting with unexpected symptoms of complex partial seizures. Skull base neuro-endoscopy has managed such lesions more effectively with reduced post-operative morbidity as compared to transcranial approach. This case report discusses a 20-year-old male who presented with 3 episodes of seizure over a time period of 10 months. MRI brain revealed T1 hypo and T2 hyper intense cystic lesion in middle cranial fossa with no enhancement on contrast administration. CT scan showed cystic lesion involving greater wing and pterygoid plate of sphenoid on left side. CT cisternographic evaluation showed CSF outpouching in the sphenoid air sinus. Excision of the cystic lesion was carried out through endoscopic transmaxillary transpterygoid approach. Histopathological examination showed the lesion to be a simple bone cyst. PMID:27891396
Xu, Yuan; Wang, Lihong V
Two-dimensional microwave-induced thermoacoustic tomography (TAT) is applied to imaging the Rhesus monkey brain through the intact skull. To reduce the wavefront distortion caused by the skull, only the low-frequency components of the thermoacoustic signals (< 1 MHz) are used to reconstruct the TAT images. The methods of signal processing and image reconstruction are validated by imaging a lamb kidney. The resolution of the system is found to be 4 mm when we image a 1-month-old monkey head containing inserted needles. We also image the coronal and axial sections of a 7-month-old monkey head. Brain features that are 3 cm deep in the head are imaged clearly. Our results demonstrate that TAT has potential for use in portable, cost-effective imagers for pediatric brains.
Suwa, Gen; Asfaw, Berhane; Kono, Reiko T; Kubo, Daisuke; Lovejoy, C Owen; White, Tim D
The highly fragmented and distorted skull of the adult skeleton ARA-VP-6/500 includes most of the dentition and preserves substantial parts of the face, vault, and base. Anatomical comparisons and micro-computed tomography-based analysis of this and other remains reveal pre-Australopithecus hominid craniofacial morphology and structure. The Ardipithecus ramidus skull exhibits a small endocranial capacity (300 to 350 cubic centimeters), small cranial size relative to body size, considerable midfacial projection, and a lack of modern African ape-like extreme lower facial prognathism. Its short posterior cranial base differs from that of both Pan troglodytes and P. paniscus. Ar. ramidus lacks the broad, anteriorly situated zygomaxillary facial skeleton developed in later Australopithecus. This combination of features is apparently shared by Sahelanthropus, showing that the Mio-Pliocene hominid cranium differed substantially from those of both extant apes and Australopithecus.
Missori, Paolo; Currà, Antonio; Paris, Harry S; Peschillo, Simone; Fattapposta, Francesco; Paolini, Sergio; Domenicucci, Maurizio
In Egyptian, Greco-Roman, and Arabic medicine, the closure of a skull defect was not provided at the end of a therapeutic trepanation or in cases of bone removal. The literature from the Middle Ages and Renaissance disclosed some striking and forgotten practices. Gilbertus Anglicus (c. 1180 to c. 1250) cites the use of a piece of a cup made from wooden bowl (ciphum or mazer) or a gold sheet to cover the gap and protect the brain in these patients; this citation probably reflected a widely known folk practice. Pietro d'Argellata introduced the use of a fixed piece of dried gourd for brain protection to reconstruct a skull defect. In the late Renaissance, the negative folklore describing this outlandish practice likely led to the use of silver and lead sheets. Nevertheless, for centuries, large numbers of surgeons preferred to leave the dura mater uncovered after bone removal, and failed to apply any brain protection.
Kang, Hae Ji; Arai, Satoru; Hope, Andrew G; Cook, Joseph A; Yanagihara, Richard
Genetically distinct hantaviruses have been identified recently in multiple species of shrews (Order Soricomorpha, Family Soricidae) in Eurasia and North America. To corroborate decades-old reports of hantaviral antigens in shrews from Russia, archival liver and lung tissues from 4 Siberian large-toothed shrews (Sorex daphaenodon), 5 Eurasian least shrews (Sorex minutissimus), 12 flat-skulled shrews (Sorex roboratus), and 18 tundra shrews (Sorex tundrensis), captured in the Sakha Republic in northeastern Siberia during July and August 2006, were analyzed for hantavirus RNA by reverse transcription-polymerase chain reaction. A novel hantavirus, named Kenkeme virus, was detected in a flat-skulled shrew. Sequence analysis of the full-length S and partial M and L segments indicated that Kenkeme virus was genetically and phylogenetically distinct from Seewis virus harbored by the Eurasian common shrew (Sorex araneus), as well as all other rodent-, soricid-, and talpid-borne hantaviruses.
Vekua, Abesalom; Lordkipanidze, David; Rightmire, G Philip; Agusti, Jordi; Ferring, Reid; Maisuradze, Givi; Mouskhelishvili, Alexander; Nioradze, Medea; De Leon, Marcia Ponce; Tappen, Martha; Tvalchrelidze, Merab; Zollikofer, Christoph
Another hominid skull has been recovered at Dmanisi (Republic of Georgia) from the same strata in which hominid remains have been reported previously. The Dmanisi site dated to approximately 1.75 million years ago has now produced craniofacial portions of several hominid individuals, along with many well-preserved animal fossils and quantities of stone artifacts. Although there are certain anatomical differences among the Dmanisi specimens, the hominids do not clearly represent more than one taxon. We assign the new skull provisionally to Homo erectus (=ergaster). The Dmanisi specimens are the most primitive and small-brained fossils to be grouped with this species or any taxon linked unequivocally with genus Homo and also the ones most similar to the presumed habilis-like stem. We suggest that the ancestors of the Dmanisi population dispersed from Africa before the emergence of humans identified broadly with the H. erectus grade.
Shibuya, Terry Y.; Doerr, Timothy D.; Mathog, Robert H.; Burgio, Don L.; Meleca, Robert J.; Yoo, George H.; Guthikonda, Murali
The retromaxillary-infratemporal fossa (RM-ITF) dissection, using a preauricular incision, was initially popularized for the treatment of temporomandibular joint disorders, facial fractures, and orbital tumors. This approach has been expanded for the treatment of advanced head and neck and skull base tumors extending into the infratemporal fossa. We studied prospectively eight consecutive patients requiring a RM-ITF dissection. Pre- and postoperative functional outcomes measured were mastication, speech, swallowing, cranial nerve function, pain, and cosmesis. A significant reduction in pain was noted postoperatively in all patients studied. Limited changes were identified in mastication, speech, swallowing, vision, hearing, or cosmesis postoperatively. The RM-ITF dissection should be considered when resecting advanced head and neck/skull base lesions that extend into this region. We have found minimal morbidity associated with this dissection. This procedure may have a useful place in palliation of patients with incurable pain caused by tumor invasion into the infratemporal fossa. ImagesFigure 2Figure 3Figure 4 PMID:17171134
Cash, Sydney S.
Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3–4 in consumable plastic filament as described, and the total process takes 14–17 hours, almost all of which is unsupervised (preprocessing = 4–6 hr; printing = 9–11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1–5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes. PMID:26295459
Naftulin, Jason S; Kimchi, Eyal Y; Cash, Sydney S
Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3-4 in consumable plastic filament as described, and the total process takes 14-17 hours, almost all of which is unsupervised (preprocessing = 4-6 hr; printing = 9-11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1-5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.
Kim, Dae Hwan
Giant cell tumors are benign but locally invasive and frequently recur. Giant cell tumors of the skull are extremely rare. A patient underwent a surgery to remove a tumor, but the tumor recurred. Additionally, the patient developed multiple aneurysms. The patient underwent total tumor resection and trapping for the aneurysms, followed by radiotherapy. We report this rare case and suggest some possibilities for treating tumor growth combined with aneurysm development. PMID:27195256
Hood, James W.; Waddell, K.M.
This report is the second in a series by the U.S. Geological Survey in cooperation with the Utah Department of Natural Resources, Division of Water Rights, which describes the water resources of the western basins of Utah. Its purpose is to present available hydrologic data on Skull Valley, to provide an evaluation of the potential water-resource development of the valley, and to identify needed studies that would help provide an understandingof the valley's water supply.
Johnson, Michele H; Thorisson, Hjalti M; Diluna, Michael L
Knowledge of the anatomy of the vasculature of the head and neck from the thorax to the skull base is critical to the approach to diagnosis and treatment of cerebrovascular disease. Awareness of the anatomic variations that may be encountered, common and uncommon, is necessary to avoid diagnostic pitfalls and to avert therapeutic disasters. Careful anatomic analysis and understanding of collateral pathways and dangerous anastomoses facilitates cross-sectional and angiographic diagnosis and the development of surgical and endovascular treatment strategies.
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Guangdi, S I; Dong, Yiyi; Ma, Yujun; Zhang, Zihui
Feeding adaptations are a conspicuous feature of avian evolution. Bill and cranial shape as well as the jaw muscles are closely related to diet choice and feeding behaviors. Diurnal raptors of Falconiformes exhibit a wide range of foraging behaviors and prey preferences, and are assigned to seven dietary groups in this study. Skulls of 156 species are compared from the dorsal, lateral and ventral views, by using geometric morphometric techniques with those landmarks capturing as much information as possible on the overall shape of cranium, bill, orbits, nostrils and attachment area for different jaw muscles. The morphometric data showed that the skull shape of scavengers differ significantly from other raptors, primarily because of different feeding adaptations. As a result of convergent evolution, different scavengers share generalized common morphology, possessing relatively slender and lower skulls, longer bills, smaller and more sideward orbits, and more caudally positioned quadrates. Significant phylogenetic signals suggested that phylogeny also played important role in shape variation within scavengers. New World vultures can be distinguished by their large nostrils, narrow crania and small orbits; Caracaras typically show large palatines, crania and orbits, as well as short, deep and sharp bill.
Macía, G; Picón, M; Nuñez, J; Almeida, F; Alvarez, I; Acero, J
Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored.
Ibáñez, O; Cavalli, F; Campomanes-Álvarez, B R; Campomanes-Álvarez, C; Valsecchi, A; Huete, M I
Objective and unbiased validation studies over a significant number of cases are required to get a more solid picture on craniofacial superimposition reliability. It will not be possible to compare the performance of existing and upcoming methods for craniofacial superimposition without a common forensic database available for the research community. Skull-face overlay is a key task within craniofacial superimposition that has a direct influence on the subsequent task devoted to evaluate the skull-face relationships. In this work, we present the procedure to create for the first time such a dataset. We have also created a database with 19 skull-face overlay cases for which we are trying to overcome legal issues that allow us to make it public. The quantitative analysis made in the segmentation and registration stages, together with the visual assessment of the 19 face-to-face overlays, allows us to conclude that the results can be considered as a gold standard. With such a ground truth dataset, a new horizon is opened for the development of new automatic methods whose performance could be now objectively measured and compared against previous and future proposals. Additionally, other uses are expected to be explored to better understand the visual evaluation process of craniofacial relationships in craniofacial identification. It could be very useful also as a starting point for further studies on the prediction of the resulting facial morphology after corrective or reconstructive interventionism in maxillofacial surgery.
Zanoletti, E; Cazzador, D; Faccioli, C; Martini, A; Mazzoni, A
Closure of the sigmoid-jugular complex is generally planned during various surgical procedures on the skull base, either to repair a jugular foramen lesion or as the oncological boundary of the resection. A series of 218 cases of skull base tumour surgeries was analysed in which closure of the sigmoid-jugular complex was systematically planned (bilaterally in one case) in patients treated for jugular foramen paragangliomas, squamous cell carcinomas and other temporal bone tumours. Surgery was performed via a petro-occipital trans-sigmoid approach in 61 cases, an infratemporal A in 128, en bloc subtotal temporal bone resections in 10 and other approaches in 20. In our experience, planned unilateral (and, in one case, bilateral) closure of the sigmoid-jugular complex had no clinical consequences. The vicarious drainage of the skull base was always assessed preoperatively, revealing no contraindications to intraoperative sinus closure. Given the scarcity of literature on this subject, the present report shows that the procedure is associated with low morbidity and helps to improve our understanding of cerebral venous discharge.
Netto, Dante Simionato; Nascimento, Sergio Ricardo Rios; Ruiz, Cristiane Regina
Objective To analyze the variations in the angle basal sphenoid skulls of adult humans and their relationship to sex, age, ethnicity and cranial index. Methods The angles were measured in 160 skulls belonging to the Museum of the Universidade Federal de São Paulo Department of Morphology. We use two flexible rules and a goniometer, having as reference points for the first rule the posterior end of the ethmoidal crest and dorsum of the sella turcica, and for the second rule the anterior margin of the foramen magnum and clivus, measuring the angle at the intersection of two. Results The average angle was 115.41°, with no statistical correlation between the value of the angle and sex or age. A statistical correlation was noted between the value of the angle and ethnicity, and between the angle and the horizontal cranial index. Conclusions The distribution of the angle basal sphenoid was the same in sex, and there was correlation between the angle and ethnicity, being the proportion of non-white individuals with an angle >125° significantly higher than that of whites with an angle >125°. There was correlation between the angle and the cranial index, because skulls with higher cranial index tend to have higher basiesfenoidal angle too. PMID:25295452
Khonsari, R H; Friess, M; Nysjö, J; Odri, G; Malmberg, F; Nyström, I; Messo, E; Hirsch, J M; Cabanis, E A M; Kunzelmann, K H; Salagnac, J M; Corre, P; Ohazama, A; Sharpe, P T; Charlier, P; Olszewski, R
Intentional cranial deformations (ICD) have been observed worldwide but are especially prevalent in preColombian cultures. The purpose of this study was to assess the consequences of ICD on three cranial cavities (intracranial cavity, orbits, and maxillary sinuses) and on cranial vault thickness, in order to screen for morphological changes due to the external constraints exerted by the deformation device. We acquired CT-scans for 39 deformed and 19 control skulls. We studied the thickness of the skull vault using qualitative and quantitative methods. We computed the volumes of the orbits, of the maxillary sinuses, and of the intracranial cavity using haptic-aided semi-automatic segmentation. We finally defined 3D distances and angles within orbits and maxillary sinuses based on 27 anatomical landmarks and measured these features on the 58 skulls. Our results show specific bone thickness patterns in some types of ICD, with localized thinning in regions subjected to increased pressure and thickening in other regions. Our findings confirm that volumes of the cranial cavities are not affected by ICDs but that the shapes of the orbits and of the maxillary sinuses are modified in circumferential deformations. We conclude that ICDs can modify the shape of the cranial cavities and the thickness of their walls but conserve their volumes. These results provide new insights into the morphological effects associated with ICDs and call for similar investigations in subjects with deformational plagiocephalies and craniosynostoses.
Santana, S E; Lofgren, S E
In vertebrates, changes in cranial modularity can evolve rapidly in response to selection. However, mammals have apparently maintained their pattern of cranial integration throughout their evolutionary history and across tremendous morphological and ecological diversity. Here, we use phylogenetic, geometric morphometric and comparative analyses to test the hypothesis that the modularity of the mammalian skull has been remodelled in rhinolophid bats due to the novel and critical function of the nasal cavity in echolocation. We predicted that nasal echolocation has resulted in the evolution of a third cranial module, the 'nasal dome', in addition to the braincase and rostrum modules, which are conserved across mammals. We also test for similarities in the evolution of skull shape in relation to habitat across rhinolophids. We find that, despite broad variation in the shape of the nasal dome, the integration of the rhinolophid skull is highly consistent with conserved patterns of modularity found in other mammals. Across their broad geographical distribution, cranial shape in rhinolophids follows two major divisions that could reflect adaptations to dietary and environmental differences in African versus South Asian distributions. Our results highlight the potential of a relatively simple modular template to generate broad morphological and functional variation in mammals.
Naunheim, Matthew R.; Sedaghat, Ahmad R.; Lin, Derrick T.; Bleier, Benjamin S.; Holbrook, Eric H.; Curry, William T.; Gray, Stacey T.
Objectives To characterize the temporal distribution and resolution rate of postoperative complications from endoscopic skull base surgery. Design Retrospective review of patients undergoing endoscopic resection of paranasal sinus or skull base neoplasm from 2007 to 2013. Setting Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center. Participants Fifty-eight consecutive patients. Main Outcome Measures Postoperative complications were categorized as cerebrospinal fluid (CSF) leak, pituitary, orbital, intracranial, or sinonasal. Complications were temporally categorized as “perioperative” (within 1 week), “early” (after 1 week and within 6 months), or “delayed” (after 6 months). Results The most common perioperative complications were diabetes insipidus (19.0%), CSF leak (5.2%), and meningitis (5.2%), with resolution rates of 75%, 100%, and 100%, respectively. Overall, CSF leak occurred in 13.8% of patients and resolved in all cases. A total of 53.8% of all complications were evident within 1 week of surgery. Chronic rhinosinusitis was the most common delayed complication (3.4%). Hypopituitarism and delayed complications were less likely to resolve (p = 0.014 and p = 0.080, respectively). Conclusions Monitoring of complications after endoscopic skull base surgery should focus on neurologic complications and CSF leak in the early postoperative period and development of chronic rhinosinusitis in the long term. Late-onset complications and hypopituitarism are less likely to resolve. PMID:26401482
We analyzed the variability in position, shape, size and incidence of the infraorbital foramen in Indian dry skulls as little literature is available on this foramen in Indians to prevent clinical complications during maxillofacial surgery and regional block anesthesia. Fifty-five Indian skulls from the Department of Anatomy CSM Medical University were examined. The 110 sides (left and right) of the skulls were analyzed by measuring the infraorbital foramina distances from infraorbital margin and the piriform aperture on both sides. The vertical and horizontal dimensions were also measured. All measurements were taken with a compass transferred to calipers and analyzed statistically. The mean distances between the infraorbital foramen and the infraorbital margin on the right and left side were 6.12 mm and 6.19 mm, respectively. The mean distances between the infraorbital foramen and the piriform aperture were 15.31 mm and 15.80 mm on the right and left sides, respectively. The mean vertical dimensions on the right and left side were 3.39 mm and 3.75 mm, respectively. The mean horizontal dimensions on the two sides were 3.19 mm and 3.52 mm. These results provide detailed knowledge of the anatomical characteristics and clinical importance of the infraorbital foramina which are of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia. PMID:21519552
Sawhney, Raja; Brown, Ryan; Ducic, Yadranko
The purpose of this article is to review the basic indications for different treatments of condylar and subcondylar fractures. It also reviews the steps of different surgical approaches to access the surgical area and explains the pros and cons of each procedure.
Trouth, C O; Winter, S; Gupta, K C; Millis, R M; Holloway, J A
Sexual differences in the basioccipital portion of the skull of dogs have been described and an index is presented which reliably predicts the sex of the skull. 92 dolichocephalic skull (44 male, 48 female) from mongrel dogs were used. In the basioccipital region of the male skulls, a triangular area, which extends from the basion to a line joining the medialmost points of the two jugular foramina, appears narrow and elevated. The pharyngeal tubercle is also prominent. In female skulls the rostral angle of this triangle is wider and the triangular area seems smoother and flat. The anterior half of the female basioccipital portion is wider and smoother than in the male skull. In order to quantify the observed differences, four indices were calculated. All of the indices were statistically significant. However, only index IV could be reliably used in predicting the sex of an unknown skull: (formula: see text) was derived from breadth IV (distance between the two temporo-occipital fissures at their lateralmost points) and length II (distance between the basion and a line drawn between the two medialmost points of the jugular foramina in the midline). Values of less than 123 for male and greater than 136 for female placed the skulls in their proper sex group. Skulls that had intermediate values could be placed in correct sex grouping only in conjunction with strong observational criteria. It is suggested that in absence of such strong observational criteria these skulls may belong to immature or castrate animals.
Brand, Yves; Waran, Vicknes; Zulkiflee, Abu Bakar; Lim, Elizabeth; Prepageran, Narayanan
The skull base is one of the most complex anatomical regions and forms the floor of the cranial cavity. Skull base surgery involves open, microscopic, and endoscopic approaches to the anterior, middle, or posterior cranial fossa. A multispecialty team approach is essential in treating patients with skull base lesions. Traditionally, rhinologists are involved in providing access to anterior skull base lesions while otologists are involved in the treatment of lesions of the posterior skull base. This is the case in most skull base centers today. In this article, we share a new perspective of an integrated skull base unit where a team of otolaryngologists and neurosurgeons treat anterior, middle, and posterior skull base pathologies. The rationale for this approach is that most technical skills required in skull base surgery are interchangeable and apply whether an endoscopic or microscopic approach is used. We show how the different skills apply to the different approaches and share our experience with an integrated skull base unit. PMID:26258128
Kleinteich, Thomas; Maddin, Hillary C; Herzen, Julia; Beckmann, Felix; Summers, Adam P
Caecilians (Lissamphibia: Gymnophiona) are characterized by a fossorial lifestyle that appears to play a role in the many anatomical specializations in the group. The skull, in particular, has been the focus of previous studies because it is driven into the substrate for burrowing. There are two different types of skulls in caecilians: (1) stegokrotaphic, where the squamosal completely covers the temporal region and the jaw closing muscles, and (2) zygokrotaphic, with incomplete coverage of the temporal region by the squamosal. We used 3-D imaging and modeling techniques to explore the functional consequences of these skull types in an evolutionary context. We digitally converted stegokrotaphic skulls into zygokrotaphic skulls and vice versa. We also generated a third, akinetic skull type that was presumably present in extinct caecilian ancestors. We explored the benefits and costs of the different skull types under frontal loading at different head angles with finite element analysis (FEA). Surprisingly, the differences in stress distributions and bending between the three tested skull types were minimal and not significant. This suggests that the open temporal region in zygokrotaphic skulls does not lead to poorer performance during burrowing. However, the results of the FEA suggest a strong relationship between the head angle and skull performance, implying there is an optimal head angle during burrowing.
Timm-Davis, Lori L.; DeWitt, Thomas J.; Marshall, Christopher D.
Variation in terrestrial mammalian skull morphology is known to constrain feeding performance, which in turn influences dietary habits and ultimately fitness. Among mustelids, otters have evolved two feeding specializations: underwater raptorial capture of prey (mouth-oriented) and capture of prey by hand (hand-oriented), both of which have likely associations with morphology and bite performance. However, feeding biomechanics and performance data for otters are sparse. The first goal of this study was to investigate the relationships between feeding morphology and bite performance among two mouth-oriented piscivores (Pteronura brasiliensis and Lontra canadensis) and two hand-oriented invertebrate specialists (Enhydra lutris and Aonyx cinerea). Since other vertebrate taxa that are mouth-oriented piscivores tend to possess longer skulls and mandibles, with jaws designed for increased velocity at the expense of biting capability, we hypothesized that mouth-oriented otters would also possess long, narrow skulls indicative of high velocity jaws. Conversely, hand-oriented otters were expected to possess short, blunt skulls with adaptations to increase bite force and crushing capability. Concomitant with these skull shapes we hypothesized that sea otters would possess a greater mandibular bluntness index, providing for a greater mechanical advantage compared to other otter species investigated. A second goal was to examine morphological variation at a finer scale by assessing variation in cranial morphology among three sea otter subspecies. Since diet varies among these subspecies, and their populations are isolated, we hypothesized that the magnitude of mandibular bluntness and concomitant mechanical advantage, as well as occlusal surface area would also vary within species according to their primary food source (fish versus hard invertebrates). Functional expectations were met for comparisons among and within species. Among species the phylogeny suggests a deeply
Firestone, R. B.; West, A.; Stefanka, Z.; Revay, Z.; Hagstrum, J. T.
We have discovered what appear to be micrometeorites imbedded in seven Alaskan Mammoth tusks and a Siberian bison skull. The micrometeorites apparently shattered on impact leaving 2-5 mm hemispherical debris patterns surrounded by carbonized rings. Multiple impacts are observed on only one side of the tusks and skull consistent with the micrometeorites having come from a single direction. The impact sites are strongly magnetic indicating significant iron content. We analyzed several imbedded micrometeorite fragments from both tusks and skull with Laser Ablation Inductively-Coupled Plasma Mass Spectrometry (LA-ICP-MS) and X-ray Fluorescence (XRF). These analyses confirmed the high iron content and a uniform composition highly enriched in nickel and depleted in titanium. The Fe/Ni and Fe/Ti ratios are comparable to urelite meteorites and are unlike any terrestrial sources. Prompt Gamma-ray Activation Analysis (PGAA) of a micrometeorite extracted from the bison skull indicated it contained ~0.4 mg of iron, in agreement with a micrometeorite ~1 mm in diameter. Several tusks have an average radiocarbon age of ~33 ka. This age coincides with sudden increases in global radiocarbon ~35 ka agoa and 10Be ~32 ka agob, the Mono Lake geomagnetic excursion ~34 ka agoc, and significant declines in Beringian bison, horse, brown bear, and mammoth populations and genetic diversity <36 ka agod. The bison skull shows evidence of new bone growth over the micrometeorite impact sites indicating the animal survived the bombardment and is dated at ~26 ka which is younger than the tusks. This age is consistent with exposure of the bison to an enriched source of radiocarbon following the impact. It appears likely that the impacts, cosmogenic isotope increases, magnetic excursion, and population declines are related events (Occam's razor), although their precise nature remains to be determined. aK. Hughen, et al., Science 303, 202-207 (2004). bL.R. McHargue, P.E. Damon, & D.J. Donahue
Geurtzen, Karina; Knopf, Franziska; Wehner, Daniel; Huitema, Leonie F A; Schulte-Merker, Stefan; Weidinger, Gilbert
Zebrafish have an unlimited capacity to regenerate bone after fin amputation. In this process, mature osteoblasts dedifferentiate to osteogenic precursor cells and thus represent an important source of newly forming bone. By contrast, differentiated osteoblasts do not appear to contribute to repair of bone injuries in mammals; rather, osteoblasts form anew from mesenchymal stem cells. This raises the question whether osteoblast dedifferentiation is specific to appendage regeneration, a special feature of the lepidotrichia bone of the fish fin, or a process found more generally in fish bone. Here, we show that dedifferentiation of mature osteoblasts is not restricted to fin regeneration after amputation, but also occurs during repair of zebrafish fin fractures and skull injuries. In both models, mature osteoblasts surrounding the injury downregulate the expression of differentiation markers, upregulate markers of the pre-osteoblast state and become proliferative. Making use of photoconvertible Kaede protein as well as Cre-driven genetic fate mapping, we show that osteoblasts migrate to the site of injury to replace damaged tissue. Our findings suggest a fundamental role for osteoblast dedifferentiation in reparative bone formation in fish and indicate that adult fish osteoblasts display elevated cellular plasticity compared with mammalian bone-forming cells.
Ohashi, M; Hosoda, Y; Fujishiro, Y; Tuyuki, A; Kikuchi, K; Obara, H; Kitagawa, N; Ishikawa, T
The present study attempts to better understand the mechanism of injuries associated with direct lightning strikes. We reviewed the records of 256 individuals struck by lightning between 1965 and 1999, including 56 people who were killed. Basal skull fracture, intracranial haemorrhage, pulmonary haemorrhage, or solid organ rupture was suspected in three men who died. Generally these lesions have been attributed to current flow or falling after being struck. However, examination of surface injuries sustained suggested that the true cause was concussion secondary to blast injury resulting from vaporization of water on the body surface by a surface flashover spark. To investigate this hypothesis, an experimental model of a lightning strike was created in the rat. Saline-soaked blotting paper was used to simulate wet clothing or skin, and an artificial lightning impulse was applied. The resultant lesions were consistent with our hypothesis that the blast was reinforced by the concussive effect of water vaporization. The concordance between the clinical and experimental evidence argues strongly for blast injury as an important source of morbidity and mortality in lightning strikes.
Jasinski, Thomas J. (Inventor); Witt, August F. (Inventor)
An improved apparatus and method for growing crystals from a melt employing a heat pipe, consisting of one or more sections, each section serving to control temperature and thermal gradients in the crystal as it forms inside the pipe.
... Pregnancy > Prenatal care > Pregnancy week by week Pregnancy week by week Week by week Videos Swipe to advance Learn ... grows each week during pregnancy. Pick your week. Weeks 1-2 Conception (also called fertilization) usually happens ...
Discusses the issue of human population. Illustrates the projections of the growing human population in terms of developed and less developed countries. Describes the family planning programs in several countries. Lists three references for further reading. (YP)
The emerging U.S. bioenergy industry provides a secure and growing supply of transportation fuels, biopower, and bioproducts produced from a range of abundant, renewable biomass resources. Bioenergy can help ensure a secure, sustainable, and economically sound future by reducing U.S. dependence on foreign oil, developing domestic clean energy sources, and generating domestic green jobs. Bioenergy can also help address growing concerns about climate change by reducing greenhouse gas emissions to create a healthier environment for current and future generations.
Li, Yuandong; Baran, Utku; Wang, Ruikang K
In vivo imaging of mouse brain vasculature typically requires applying skull window opening techniques: open-skull cranial window or thinned-skull cranial window. We report non-invasive 3D in vivo cerebral blood flow imaging of C57/BL mouse by the use of ultra-high sensitive optical microangiography (UHS-OMAG) and Doppler optical microangiography (DOMAG) techniques to evaluate two cranial window types based on their procedures and ability to visualize surface pial vessel dynamics. Application of the thinned-skull technique is found to be effective in achieving high quality images for pial vessels for short-term imaging, and has advantages over the open-skull technique in available imaging area, surgical efficiency, and cerebral environment preservation. In summary, thinned-skull cranial window serves as a promising tool in studying hemodynamics in pial microvasculature using OMAG or other OCT blood flow imaging modalities.
Zakharov, Alexander V.; Okushko, Vladimir R.; Vturin, Sergey A.; Moseychuk, Vladimir V.; Petrov, Aleksey A.; Suetenkov, Dmitry E.
Unprompted skull bones mobility not related to breathing, heart beating and other physiological reactions, using installation of original construction with control of physiological parameters by biofeedback hardware-software complex BOS-lab and BOS-pulse appliance (COMSIB, Novosibirsk, Russia) has been confirmed. Teeth eruption occurs through odontiasis canals, emerging from the funiculus. The main driving force for promoting a tooth into odontiasis canal during eruption is the unprompted skull bones mobility. A simple optical installation was made for the visualization of skull bones mobility during the investigation of the median palatine and incisors sutures. Early detection of failures of unprompted skull bones mobility and its normalization can lead to prevention of impact teeth, malocclusion, extrudocclusion and other anomalies and deformations of teeth, teeth rows, TMJ and skull. The skull bones mobility should be considered during the early preventive treatment and therapy of the consequences of injuries and malfunction of the maxillofacial area.
Nakai, H; Kawata, Y; Tamura, Y; Tanaka, T; Hodozuka, A; Hashizume, K; Tosho, T; Matsui, R; Iwakiri, H
A 61-year-old male fell from a position 1 m high when building a house. An iron rod, which protruded upward from a solid base in cement, penetrated this patient's neck 15 cm to the head and was successfully extracted by himself. On admission, he complained of headache and vomiting. General examination disclosed nasal bleeding, intraoral bleeding, and L figured skin laceration in the left side of his neck at the level of the thyroid cartilage. Mild disorientation (JCS2) was noted. Otolaryngological examination disclosed hyperemia on the left side of the vocal cord as well as at the dome of the superior pharynx. Plain skull film disclosed pneumocephalus and that a piece of bone fragment of the planum sphenoidale had penetrated the brain. CT demonstrated air in the subarachnoid space, ventricular hemorrhage, intracerebral hematoma in the right frontal lobe, and subarachnoid hemorrhage in the anterior interhemispheric fissure. CAG detected neither cerebral vascular abnormalities nor cerebral aneurysm. While staying in our department, he developed mild fever and CSF rhinorrhea. The diagnosis of bacterial meningitis was made from the CSF finding and was well controlled with conservative therapy. CSF rhinorrhea stopped spontaneously with conservative treatment. Sagittal MRI continuously demonstrated contusional hematoma in the base of the right frontal lobe just above the fractured planum sphenoidale and genu of the corpus callosum following the course of the intracranially invading iron rod. The right CAG on Day 10 demonstrated vasospasm on the A1 and a 1 cm sized saccular cerebral aneurysm at the proximal right fronto-polar artery. CAG on Day 17 again showed the persistent presence of the aneurysm. For the purpose of preventing delayed rupture of the aneurysm, radical surgical treatment was planned. Microsurgical dissection disclosed that the aneurysm was located just behind the elevated fracture of the planum sphenoidale. Severe arachnoid adhesion was noted around the
White, Lawrence M.; Marotta, Thomas R.; McLennan, Michael K.; Kassel, Edward E.
Appropriate clinical radiographic investigation, together with an understanding of the normal radiographic anatomy of the facial skeleton, allows for precise delineation of facial fracutres and associated soft tissue injuries encountered in clinical practice. A combination of multiple plain radiographic views and coronal and axial computed tomographic images allow for optimal delineation of fracture patterns. This information is beneficial in the clinical and surgical management patients with facial injuries
Li, Pengcheng; Ni, Songlin; Zhang, Li; Zeng, Shaoqun; Luo, Qingming
We discovered that laser speckle temporal contrast analysis (LSTCA) is able to access the two-dimensional (2D) cerebral blood flow velocity and vessel structure through the intact rat skull. It is demonstrated that LSTCA can significantly suppress the influence of the laser speckle from the stationary structure, such as the skull, and thus reveal the blood flow and morphology of blood vessels through the laser speckle images recorded from the intact rat skull.
Pierce, S E; Angielczyk, K D; Rayfield, E J
Variation in modern crocodilian and extinct thalattosuchian crocodylomorph skull morphology is only weakly correlated with phylogeny, implying that factors other than evolutionary proximity play important roles in determining crocodile skull shape. To further explore factors potentially influencing morphological differentiation within the Thalattosuchia, we examine teleosaurid and metriorhynchid skull shape variation within a mechanical and dietary context using a combination of finite element modelling and multivariate statistics. Patterns of stress distribution through the skull were found to be very similar in teleosaurid and metriorhynchid species, with stress peaking at the posterior constriction of the snout and around the enlarged supratemporal fenestrae. However, the magnitudes of stresses differ, with metriorhynchids having generally stronger skulls. As with modern crocodilians, a strong linear relationship between skull length and skull strength exists, with short-snouted morphotypes experiencing less stress through the skull than long-snouted morphotypes under equivalent loads. Selection on snout shape related to dietary preference was found to work in orthogonal directions in the two families: diet is associated with snout length in teleosaurids and with snout width in metriorhynchids, suggesting that teleosaurid skulls were adapted for speed of attack and metriorhynchid skulls for force production. Evidence also indicates that morphological and functional differentiation of the skull occurred as a result of dietary preference, allowing closely related sympatric species to exploit a limited environment. Comparisons of the mechanical performance of the thalattosuchian skull with extant crocodilians show that teleosaurids and long-snouted metriorhynchids exhibit stress magnitudes similar to or greater than those of long-snouted modern forms, whereas short-snouted metriorhynchids display stress magnitudes converging on those found in short-snouted modern
Zhang, Chao; Zhao, Yanjie; Shi, Rui; Zhu, Dan
In vivo cortex optical imaging is of great important for revealing both structural and functional architecture of brain with high temporal-spatial resolution. To reduce the limitation of turbid skull, researchers had to establish various skull windows or directly expose cortex through craniotomy. Here we developed a skull optical clearing method to make skull transparent. Laser speckle contrast imaging technique was used to monitor the cortical blood flow after topical treatment with the optical clearing agents. The results indicated that the image contrast increased gradually, and then maintained at a high level after 15 min for adult mice, which made the image quality and resolution of micro-vessels nearly approximate to those of exposed cortex. Both the cortical blood flow velocity almost kept constant after skull became transparent. Besides, the treatment of physiological saline on the skull could make skull return to the initial state again and the skull could become transparent again when SOCS retreated it. Thus, we could conclude that the skull optical clearing method was rapid, valid, reversible and safe, which provided us available approach for performing the cortical structural and functional imaging at high temporal-spatial resolution.
Handschuh, Stephan; Lukanov, Simeon; Naumov, Borislav
A strongly ossified and rigid skull roof, which prevents parietal kinesis, has been reported for the adults of all amphibian clades. Our μ-CT investigations revealed that the Buresch’s newt (Triturus ivanbureschi) possess a peculiar cranial construction. In addition to the typical amphibian pleurokinetic articulation between skull roof and palatoquadrate associated structures, we found flexible connections between nasals and frontals (prokinesis), vomer and parasphenoid (palatokinesis), and between frontals and parietals (mesokinesis). This is the first description of mesokinesis in urodelans. The construction of the skull in the Buresch’s newts also indicates the presence of an articulation between parietals and the exocipitals, discussed as a possible kind of metakinesis. The specific combination of pleuro-, pro-, meso-, palato-, and metakinetic skull articulations indicate to a new kind of kinetic systems unknown for urodelans to this date. We discuss the possible neotenic origin of the skull kinesis and pose the hypothesis that the kinesis in T. ivanbureschi increases the efficiency of fast jaw closure. For that, we compared the construction of the skull in T. ivanbureschi to the akinetic skull of the Common fire salamander Salamandra salamandra. We hypothesize that the design of the skull in the purely terrestrial living salamander shows a similar degree of intracranial mobility. However, this mobility is permitted by elasticity of some bones and not by true articulation between them. We comment on the possible relation between the skull construction and the form of prey shaking mechanism that the species apply to immobilize their victims. PMID:27688958
Cooper, W James; Wirgau, Rachel M; Sweet, Elly M; Albertson, R Craig
The processes that direct skull remodeling are of interest to both human-oriented studies of cranial dysplasia and evolutionary studies of skull divergence. There is increasing awareness that these two fields can be mutually informative when natural variation mimics pathology. Here we describe a zebrafish mutant line, devoid of blastema (dob), which does not have a functional fgf20a protein, and which also presents cranial defects similar to both adaptive and clinical variation. We used geometric morphometric methods to provide quantitative descriptions of the effects of the dob mutation on skull morphogenesis. In combination with "whole-mount in situ hybridization" labeling of normal fgf20a expression and assays for osteoblast and osteoclast activity, the results of these analyses indicate that cranial dysmorphologies in dob zebrafish are generated by aberrations in post-embryonic skull remodeling via decreased osteoblasotgenesis and increased osteoclastogenesis. Mutational effects include altered skull vault geometries and midfacial hypoplasia that are consistent with key diagnostic signs for multiple human craniofacial syndromes. These phenotypic shifts also mimic changes in the functional morphology of fish skulls that have arisen repeatedly in several highly successful radiations (e.g., damselfishes and East-African rift-lake cichlids). Our results offer the dob/fgf20a mutant as an experimentally tractable model with which to examine post-embryonic skull development as it relates to human disease and vertebrate evolution.
Cooper, W. James; Wirgau, Rachel M.; Sweet, Elly M.; Albertson, R. Craig
The processes that direct skull remodeling are of interest to both human-oriented studies of cranial dysplasia and evolutionary studies of skull divergence. There is increasing awareness that these two fields can be mutually informative when natural variation mimics pathology. Here we describe a zebrafish mutant line, devoid of blastema(dob), which does not have a functional fgf20a protein, and which also presents cranial defects similar to both adaptive and clinical variation. We used geometric morphometric methods to provide quantitative descriptions of the effects of the dob mutation on skull morphogenesis. In combination with whole-mount in situ hybridization labeling of normal fgf20a expression and assays for osteoblast and osteoclast activity, the results of these analyses indicate that cranial dysmorphologies in dob zebrafish are generated by aberrations in post-embryonic skull remodeling via decreased osteoblasotgenesis and increased osteoclastogenesis. Mutational effects include altered skull vault geometries and midfacial hypoplasia that are consistent with key diagnostic signs for multiple human craniofacial syndromes. These phenotypic shifts also mimic changes in the functional morphology of fish skulls that have arisen repeatedly in several highly successful radiations (e.g., damselfishes and East-African rift-lake cichlids). Our results offer the dob/fgf20a mutant as an experimentally tractable model with which to examine post-embryonic skull development as it relates to human disease and evolution. PMID:24261444
Sandu, Kishore; Monnier, Philippe; Pasche, Philippe
Resection of midline skull base lesions involve approaches needing extensive neurovascular manipulation. Transnasal endoscopic approach (TEA) is minimally invasive and ideal for certain selected lesions of the anterior skull base. A thorough knowledge of endonasal endoscopic anatomy is essential to be well versed with its surgical applications and this is possible only by dedicated cadaveric dissections. The goal in this study was to understand endoscopic anatomy of the orbital apex, petrous apex and the pterygopalatine fossa. Six cadaveric heads (3 injected and 3 non injected) and 12 sides, were dissected using a TEA outlining systematically, the steps of surgical dissection and the landmarks encountered. Dissection done by the "2 nostril, 4 hands" technique, allows better transnasal instrumentation with two surgeons working in unison with each other. The main surgical landmarks for the orbital apex are the carotid artery protuberance in the lateral sphenoid wall, optic nerve canal, lateral optico-carotid recess, optic strut and the V2 nerve. Orbital apex includes structures passing through the superior and inferior orbital fissure and the optic nerve canal. Vidian nerve canal and the V2 are important landmarks for the petrous apex. Identification of the sphenopalatine artery, V2 and foramen rotundum are important during dissection of the pterygopalatine fossa. In conclusion, the major potential advantage of TEA to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, as against the open transcranial approaches which involve more neurovascular manipulation and brain retraction. Obviously, these approaches require close cooperation and collaboration between otorhinolaryngologists and neurosurgeons.
Daniels, Karen; Schillaci, Mark; Bostwick, Joshua
A droplet of surfactant spreading on a gel substrate can produce fractures on the gel surface, which originate at the contact-line and propagate outwards in a star-burst pattern. Fractures have previously been observed to initiate through a thermal process, with the number of fractures controlled by the ratio of surface tension differential to gel shear modulus. After the onset of fracture, experiments show the arm length grows with universal power law L =t 3 / 4 that does not scale with any material parameters (Daniels et al. 2007, PRL), including super-spreading surfactants (Spandangos et al. 2012, Langmuir). We develop a model for crack growth controlled by the transport of an inviscid fluid into the fracture tip. While treating the gel as a linear material correctly predicts power-law growth, we find that only by considering a Neo-Hookean (incompressible) material do we obtain agreement with the experiments.
Chakravorty, N. K.; Das, S. K.; Kataria, M. S.
Paget's disease of bone has been known for about 100 years and the usual deformities of bone, e.g. bowed tibia, large head, are well described in medical text books. However, there does not appear to have been a description of corrugation of the skull as a recognized deformity in Paget's disease. Three cases are now described to illustrate this deformity as an unusual but valuable sign in this disease. Images Fig. 5 Fig. 6 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Figs. 7 and 8 PMID:876912
Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul
OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management
In different types of lesions, especially in frontobasal and laterobasal ones, the central base of the skull is injured, too (in about 20% of severe frontabasal lesions). Surgical treatment is necessary. Examination of intra- and infrabasal structures and localized intracranial operations may be performed by transthemoidal-transphenoidal or transpyramidal approaches. Main problems are the treatment of dura lesions, the control of hemorrhages, the examination of the optic nerve, and the compensation of disturbances of central regulation. The above experiences we gathered from patients in the ORL Clinic of Jena University.
Norris, J. Q.; Turcotte, D. L.; Rundle, J. B.
During the past few years, we have been developing a percolation model for fracking. This model provides a powerful tool for understanding the growth and properties of the complex fracture networks generated during a modern high volume hydraulic fracture stimulations of tight shale reservoirs. The model can also be used to understand the interaction between the growing fracture network and natural reservoir features such as joint sets and faults. Additionally, the model produces a power-law distribution of bursts which can easily be compared to observed microseismicity.
Jayaprakash, Paul T; Hashim, Natassha; Yusop, Ridzuan Abd Aziz Mohd
Video vision mixer based skull-photo superimposition is a popular method for identifying skulls retrieved from unidentified human remains. A report on the reliability of the superimposition method suggested increased failure rates of 17.3 to 32% to exclude and 15 to 20% to include skulls while using related and unrelated face photographs. Such raise in failures prompted an analysis of the methods employed for the research. The protocols adopted for assessing the reliability are seen to vary from those suggested by the practitioners in the field. The former include overlaying the skull- and face-images on the basis of morphology by relying on anthropometric landmarks on the front plane of the face-images and evaluating the goodness of match depending on mix-mode images; the latter consist of orienting the skull considering landmarks on both the eye and ear planes of the face- and skull-images and evaluating the match utilizing images seen in wipe-mode in addition to those in mix-mode. Superimposition of a skull with face-images of five living individuals in two sets of experiments, one following the procedure described for the research on reliability and the other applying the methods suggested by the practitioners has shown that overlaying the images on the basis of morphology depending on the landmarks on the front plane alone and assessing the match in mix-mode fails to exclude the skull. However, orienting the skull relying on the relationship between the anatomical landmarks on the skull- and face-images such as Whitnall's tubercle and exocanthus in the front (eye) plane and the porion and tragus in the rear (ear) plane as well as assessing the match using wipe-mode images enables excluding that skull while superimposing with the same set of face-images.
2219 -T851 aluminum (fractures at low stresses). The parameter KF is alloy compact specimens 1 2 and demonstrate consistent a function of specimen...Congress of 20. Walker, E. K., "The Effect of Stress Ratio Applied Mechanics, 1924. During Crack Propagation and Fatigue for 2024-T3 and 7015- T6 Aluminum ...34Stress- Corrosion Cracking in 12. Kaufman, J. G., and Nelson, F. G., "More Ti-6A1-4V Titanium Alloy in Nitrogen Tetroxide," on Specimen Size Effect in 2219
Elbow fracture - radial head - aftercare ... to 2 weeks. If you have a small fracture and your bones did not move around much, ... to see a bone doctor (orthopedic surgeon). Some fractures require surgery to: Insert pins and plates to ...
... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...
This document contains the bases of lectures delivered in Florida by a visiting Stockholm University sociology professor. The first chapter, "Growing Old in Sweden," includes information on the income, standard of living, and quality of services available to the elderly in that country. That information is presented within the changing…
Alvy, Harvey; Robbins, Pam
New school principals have the necessity to lead at the very time they are learning the ropes of their new jobs. Some essential themes are identified that can guide new principals into growing in their new leadership roles, which are presented and discussed.
Thomas, Barbara J.
"Growing through Literature" is a curriculum using Joan M. and Erik H. Erikson's theory of the Life Cycle as a structure for selecting and teaching literature to inner-city high school students at Brighton High School in Massachusetts. The program consists of four component parts: Journals, Selected Stories, Discussion, and…
Relates changing student reaction to George Orwell's "1984" over 20 years of teaching. Finds present high school students' acceptance of Orwell's bleak world vision both a sign of student honesty and a frightening indication of the growing reality of the book. (MM)
Elementary Science Study, Newton, MA.
THIS TEACHER'S GUIDE IS DESIGNED FOR USE WITH AN ELEMENTARY SCIENCE STUDY UNIT, "GROWING SEEDS," IN WHICH SUCH BASIC SCIENCE SKILLS AND PROCESSES AS MEASUREMENT, OBSERVATION, AND HYPOTHESIS FORMATION ARE INTRODUCED THROUGH STUDENT ACTIVITIES INVOLVING SEEDS, GERMINATION, AND SEEDLING GROWTH. THE MATERIALS WERE DEVELOPED FOR USE IN…
Lee, Irene K.; Phillips, Marjorie M.
This correspondence course was designed to help parents better understand their growing children and themselves as parents. The introduction briefly sketches the importance of the family in child development. Each of the five illustrated lessons contains 7 to 12 pages on one aspect of family life. Each lesson contains a set of objectives, a…
Gerboni, Giada; Henselmans, Paul W J; Arkenbout, Ewout A; van Furth, Wouter R; Breedveld, Paul
Endoscopic endonasal surgery is currently regarded as the 'gold standard' for operating on pituitary gland tumors, and is becoming more and more accepted for treatment of other skull base lesions. However, endoscopic surgical treatment of most skull base pathologies, including certain pituitary tumors, is severely impaired by current instruments lack of maneuverability. Especially, gaining access to, and visibility of, difficult-to-reach anatomical corners without interference with surrounding neurovascular structures or other instruments, is a challenge. In this context there is the need for instruments that are able to provide a stable shaft position, while both the orientation and the position of the end-effector can be independently controlled. Current instruments that allow for this level of maneuverability are usually mechanically complex, and hence less suitable for mass production. This study therefore focuses on the development of a new actuation technique that allows for the required maneuverability while reducing the construction complexity. This actuation technique, referred to as multi-actuation, integrates multiple cable routings into a single steerable structure. Multi-actuation has been successfully integrated and tested in a handheld prototype instrument called HelixFlex. HelixFlex contains a 4 degrees of freedom maneuverable 5.8 mm (diameter) tip and shows promising results concerning its maneuverability and potential rigidity.
Prasad, Gautam; Joshi, Anand A.; Feng, Albert; Toga, Arthur W.; Thompson, Paul M.; Terzopoulos, Demetri
Background Segmentation methods for medical images may not generalize well to new data sets or new tasks, hampering their utility. We attempt to remedy these issues using deformable organisms to create an easily customizable segmentation plan. We validate our framework by creating a plan to locate the brain in 3D magnetic resonance images of the head (skull-stripping). New Method Our method borrows ideas from artificial life to govern a set of deformable models. We use control processes such as sensing, proactive planning, reactive behavior, and knowledge representation to segment an image. The image may have landmarks and features specific to that dataset; these may be easily incorporated into the plan. In addition, we use a machine learning method to make our segmentation more accurate. Results Our method had the least Hausdorff distance error, but included slightly less brain voxels (false negatives). It also had the lowest false positive error and performed on par to skull-stripping specific method on other metrics. Comparison with Existing Method(s) We tested our method on 838 T1-weighted images, evaluating results using distance and overlap error metrics based on expert gold standard segmentations. We evaluated the results before and after the learning step to quantify its benefit; we also compare our results to three other widely used methods: BSE, BET, and the Hybrid Watershed algorithm. Conclusions Our framework captures diverse categories of information needed for brain segmentation and will provide a foundation for tackling a wealth of segmentation problems. PMID:25124851
Sahillioğlu, Yusuf; Kavan, Ladislav
We present an algorithm for volumetric registration of 3D solid shapes. In comparison to previous work on image based registration, our technique achieves higher efficiency by leveraging a template tetrahedral mesh. In contrast to point- and surface-based registration techniques, our method better captures volumetric nature of the data, such as bone thickness. We apply our algorithm to study pathological skull deformities caused by a particular condition, i.e., craniosynostosis. The input to our system is a pair of volumetric 3D shapes: a tetrahedral mesh and a voxelized object represented by a set of voxel cells segmented from computed tomography (CT) scans. Our general framework first performs a global registration and then launches a novel elastic registration process that uses as much volumetric information as possible while deforming the generic template tetrahedral mesh of a healthy human skull towards the underlying geometry of the voxel cells. Both data are high-resolution and differ by large non-rigid deformations. Our fully-automatic solution is fast and accurate, as compared with the state of the arts from the reconstruction and medical image registration fields. We use the resulting registration to match the ground-truth surfaces extracted from the medical data as well as to quantify the severity of the anatomical deformity.
Tao, Xiaodong; Chang, Ming-Ching
Many neuroimaging applications require an initial step of skull stripping to extract the cerebrum, cerebellum, and brain stem. We approach this problem by combining deformable surface models and a fuzzy tissue classification technique. Our assumption is that contrast exists between brain tissue (gray matter and white matter) and cerebrospinal fluid, which separates the brain from the extra-cranial tissue. We first analyze the intensity of the entire image to find an approximate centroid of the brain and initialize an ellipsoidal surface around it. We then perform a fuzzy tissue classification with bias field correction within the surface. Tissue classification and bias field are extrapolated to the entire image. The surface iteratively deforms under a force field computed from the tissue classification and the surface smoothness. Because of the bias field correction and tissue classification, the proposed algorithm depends less on particular imaging contrast and is robust to inhomogeneous intensity often observed in magnetic resonance images. We tested the algorithm on all T1 weighted images in the OASIS database, which includes skull stripping results using Brain Extraction Tool; the Dice scores have an average of 0.948 with a standard deviation of 0.017, indicating a high degree of agreement. The algorithm takes on average 2 minutes to run on a typical PC and produces a brain mask and membership functions for gray matter, white matter, and cerebrospinal fluid. We also tested the algorithm on T2 images to demonstrate its generality, where the same algorithm without parameter adjustment gives satisfactory results.
Herwig, Kyle Jeffry
Several recent studies have shown the importance of understanding the nature of blast injuries. Traditionally, the lungs and other air filled organs were the focus of these injuries but it is being discovered that some level of brain trauma may result after encountering a blast. These injuries are referred to as traumatic brain injuries, or TBI. There has been many clinical studies and statistical analyses done concerning these injuries, but there is still no physical understanding of the problem. In order to develop a model of how this injury can occur, rate dependent material properties of the tissues the stress wave will travel through are needed. In this study, the compressive response of porcine skull bone through the thickness direction was experimentally determined over a wide range of rates, ranging from 0.001 sec -1 to approximately 3000 sec-1. The results reveal that for most mechanical properties there is a clear rate dependence of the material. However, only one subset of the skull section appeared to have a rate dependent initial modulus, with the rest showing no significant statistical dependence on loading rate. Other mechanical properties appeared to be affected by the loading rate, including the strain energy density.
Ye, Zhen; Lin, Zhongmin; Lu, Cheng-chang
Region growing is one of the most popular methods for low-level image segmentation. Many researches on region growing have focused on the definition of the homogeneity criterion or growing and merging criterion. However, one disadvantage of conventional region growing is redundancy. It requires a large memory usage, and the computation-efficiency is very low especially for 3D images. To overcome this problem, a non-recursive single-pass 3D region growing algorithm named SymRG is implemented and successfully applied to 3D CT angiography (CTA) applications for vessel segmentation and bone removal. The method consists of three steps: segmenting one-dimensional regions of each row; doing region merging to adjacent rows to obtain the region segmentation of each slice; and doing region merging to adjacent slices to obtain the final region segmentation of 3D images. To improve the segmentation speed for very large volume 3D CTA images, this algorithm is applied repeatedly to newly updated local cubes. The next new cube can be estimated by checking isolated segmented regions on all 6 faces of the current local cube. This local non-recursive 3D region-growing algorithm is memory-efficient and computation-efficient. Clinical testings of this algorithm on Brain CTA show this technique could effectively remove whole skull, most of the bones on the skull base, and reveal the cerebral vascular structures clearly.
Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou
Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.
Nasi, D.; Iacoangeli, M.; Dallari, S.; Salvinelli, F.; Dobran, M.; di Somma, L.; Colasanti, R.; Nocchi, N.; Vaira, C.; Scerrati, M.
INTRODUCTION: Malignant tumors of anterior skull base represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches (EEEA) have been developed, either alone or combined with transcranial approaches for treatment of these malignant lesions. We report our experience to illustrate the relative safety and effectiveness of the EEEA for skull base malignancies alone or combined when possible with minimally invasive approaches or traditional surgery. METHODS: From June 2009, 13 patients harbouring malignant neoplastic lesions of anterior skull base were treated at our department. Four patients affected by sinonasal malignancies with extension in anterior cranial fossa underwent to combined open subfrontal or minimally invasive supra orbital approach and EEEA. In 2 patients with respectively esthesioneuroblastoma and maxillary sinus squamous cell carcinoma a combined supraorbital key-hole craniotomy and EEEA were perfomed. Seven clival metastases with VI cranial nerve palsy were approached by the EEEA supplemented by neuronavigation. RESULTS: Gross total removal was performed in 9 out of 13 patients. In the other cases partial resection, but with adequate decompression and diagnosis were achieved. There were no mortality, 1 patient had infection and 1 deep vein thrombosis. CONCLUSIONS: In our experience EEEA are an integral part of the neurosurgical armamentarium for the treatment of the skull base malignancies. In properly selected cases, it affords similar oncologic outcomes with lower morbidity than traditional open approaches. The major potential advantage of the EEEA approach is direct “natural” anatomical route to the lesion without traversing any major neurovascular structures, so obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as
The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.
Hayt, D B; Blatt, C J; Goldman, S M; Moses, D C
We present two cases of myelomatous involvement of the skull. Correlative studies with routine radiography, angiography, and encephaloscintigraphy were performed. The areas of involvement of the skull were confirmed as autopsy. A mixed pattern of photon-deficient and photon-abundant lesions was noted. The clinician should be aware of such mixed patterns.
Throughout his scientific career, the pathologist and anthropologist Rudolf Virchow (1821-1902) examined countless skulls, gradually changing his perspective on this object of research. Initially, he was mainly concerned with pathologically deformed skulls. From the 1850s onwards, he gradually developed a more anthropological approach, and anthropology increasingly came to dominate his scientific interest. This article shows how different influences became central for the establishment of his specific and dynamic model of the human skull development and its successful application in anthropology. Crucial for this process were Virchow's collaboration with his teacher Robert Froriep (1804-1861) in the department of pathology of the Charité, his research on cretinism and rickets, as well as his description of the base of the skull as the center of skull development. His research work was attended by and showed a reciprocal interaction with the buildup of large skull collections. This article uses Virchow's original publications on skull pathology as well as his still preserved skull specimens from the collection of the Berlin Museum of Medical History at the Charité for an integrated text and object based analysis.
Price, Rebecca M.
This activity uses inquiry to investigate how large changes in shape can evolve from small changes in the timing of development. Students measure skull shape in fetal, infant, juvenile, and adult chimpanzees and compare them to adult skulls of "Homo sapiens," "Homo erectus," and "Australopithecus afarensis." They conclude by re-interpreting their…
Moazen, M; Curtis, N; Evans, S E; O'Higgins, P; Fagan, M J
Lizard skulls vary greatly in shape and construction, and radical changes in skull form during evolution have made this an intriguing subject of research. The mechanics of feeding have surely been affected by this change in skull form, but whether this is the driving force behind the change is the underlying question that we are aiming to address in a programme of research. Here we have implemented a combined finite element analysis (FEA) and multibody dynamics analysis (MDA) to assess skull biomechanics during biting. A skull of Uromastyx hardwickii was assessed in the present study, where loading data (such as muscle force, bite force and joint reaction) for a biting cycle were obtained from an MDA and applied to load a finite element model. Fifty load steps corresponding to bilateral biting towards the front, middle and back of the dentition were implemented. Our results show the importance of performing MDA as a preliminary step to FEA, and provide an insight into the variation of stress during biting. Our findings show that higher stress occurs in regions where cranial sutures are located in functioning skulls, and as such support the hypothesis that sutures may play a pivotal role in relieving stress and producing a more uniform pattern of stress distribution across the skull. Additionally, we demonstrate how varying bite point affects stress distributions and relate stress distributions to the evolution of metakinesis in the amniote skull. PMID:19014357
Hauser, G; Kritscher, H
The results of a detailed morphological analysis of the skull attributed to Mozart are presented which refute a recent claim that the skull as well as several of Mozart's portraits show indications of uncomplicated trigonocephaly. These indications according to the present analysis are within the limits of normal variation and derive from retention of part of the long arm of the anterior fontanelle.
Snyderman, Carl H; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A
The management of sinonasal and ventral skull base malignancies is best performed by a team. Although the composition of the team may vary, it is important to have multidisciplinary representation. There are multiple obstacles, both individual and institutional, that must be overcome to develop a highly functioning team. Adequate training is an important part of team-building and can be fostered with surgical telementoring. A quality improvement program should be incorporated into the activities of a skull base team.
Bhatki, Amol M; Carrau, Ricardo L; Snyderman, Carl H; Prevedello, Daniel M; Gardner, Paul A; Kassam, Amin B
Skull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.
Kerr, Edward E; Prevedello, Daniel M; Jamshidi, Ali; Ditzel Filho, Leo F; Otto, Bradley A; Carrau, Ricardo L
Endoscopic expanded endonasal approaches (EEAs) to the skull base are increasingly being used to address a variety of skull base pathologies. Postoperative CSF leakage from the large skull base defects has been well described as one of the most common complications of EEAs. There are reports of associated formation of delayed subdural hematoma and tension pneumocephalus from approximately 1 week to 3 months postoperatively. However, there have been no reports of immediate complications of high-volume CSF leakage from EEA skull base surgery. The authors describe two cases of EEAs in which complications related to rapid, large-volume CSF egress through the skull base surgical defect were detected in the immediate postoperative period. Preventive measures to reduce the likelihood of these immediate complications are presented.
Tsysar, S. A.; Nikolaeva, A. V.; Svet, V. D.; Khokhlova, V. A.; Yuldashev, P. V.; Sapozhnikov, O. A.
In the paper the use of receiving and radiating system, which allows to determine the parameters of bone by nonlinear pulse-echo technique and to image of brain structures through the skull bones, was proposed. Accuracy of the skull bone characterization is due to higher measured harmonic and is significantly better than in linear case. In the experimental part focused piezoelectric transducer with diameter 100 mm, focal distance 100 mm, the frequency of 1.092 MHz was used. It was shown that skull bone profiling can be performed with the use of 3rd harmonic since 1st harmonic can be used for visualization of the underlying objects. The use of wideband systems for both skull profiling and brain visualization is restricted by skull attenuation and resulting low effective sensitivity.
Tsysar, S. A. Nikolaeva, A. V.; Khokhlova, V. A.; Yuldashev, P. V.; Svet, V. D.; Sapozhnikov, O. A.
In the paper the use of receiving and radiating system, which allows to determine the parameters of bone by nonlinear pulse-echo technique and to image of brain structures through the skull bones, was proposed. Accuracy of the skull bone characterization is due to higher measured harmonic and is significantly better than in linear case. In the experimental part focused piezoelectric transducer with diameter 100 mm, focal distance 100 mm, the frequency of 1.092 MHz was used. It was shown that skull bone profiling can be performed with the use of 3rd harmonic since 1st harmonic can be used for visualization of the underlying objects. The use of wideband systems for both skull profiling and brain visualization is restricted by skull attenuation and resulting low effective sensitivity.
Irurita, Javier; Alemán, Inmaculada; Viciano, Joan; López-Lázaro, Sandra; Botella, Miguel Cecilio
One of the most common conditions during fetal development is anencephaly, which often involves many identification difficulties in the context of physical anthropology, as it causes severe skull challenges. In this paper, we describe the alterations found in the skulls of two perinatal individuals with anencephaly from the osteological collection of identified infants in the Anthropology Laboratory of the University of Granada, Spain. Both subjects of study are in perfect state of preservation. Despite the severe malformations, all skull bones have been targeted and identified, as the possibility of studying a subject with a complete, articulated, and partially mummified skull; the other was disjointed and well preserved. The skull bones of these two individuals affected with anencephaly have been described in detail, allowing this pathological condition to be identified in skeletonized individuals in archaeological or forensic contexts, in cases where these bones did not have anatomical connection or when these were taphonomically altered.
Jin, Jing; De Ribaupierre, Sandrine; Eagleson, Roy
This paper describes a simulation framework for a clinical application involving skull-brain co-development in infants, leading to a platform for craniosynostosis modeling. Craniosynostosis occurs when one or more sutures are fused early in life, resulting in an abnormal skull shape. Surgery is required to reopen the suture and reduce intracranial pressure, but is difficult without any predictive model to assist surgical planning. We aim to study normal brain-skull growth by computer simulation, which requires a head model and appropriate mathematical methods for brain and skull growth respectively. On the basis of our previous model, we further specified suture model into fibrous and cartilaginous sutures and develop algorithm for skull extension. We evaluate the resulting simulation by comparison with datasets of cases and normal growth.
Snyder, Robert S. (Inventor); Herren, Blair J. (Inventor); Carter, Daniel C. (Inventor); Yost, Vaughn H. (Inventor); Bugg, Charles E. (Inventor); Delucas, Lawrence J. (Inventor); Suddath, Fred L. (Inventor)
A macromolecular crystal growing system especially designed for growing crystals in the low gravity of space as well as the gravity of earth includes at least one tray assembly, a carrier assembly which receives the tray, and a refrigeration-incubation module in which the carrier assembly is received. The tray assembly includes a plurality of sealed chambers with a plastic syringe and a plug means for the double tip of the syringe provided therein. Ganging mechanisms operate the syringes and plugs simultaneously in a precise and smooth operation. Preferably, the tray assemblies are mounted on ball bearing slides for smooth operation in inserting and removing the tray assemblies into the carrier assembly. The plugging mechanism also includes a loading control mechanism. A mechanism for leaving a syringe unplugged is also provided.
An account is given of growing up as a child blinded as a result of a cancer of the eye known as retinoblastoma. The role of his mother is brought out, variously as a source of objective knowledge, of one's personal worth, and of the worth of other people in one's community. The strengths and weaknesses of his first school in his home area and…
Weber, J; Collmann, H; Czarnetzki, A; Spring, A; Pusch, C M
The aim of this study was to perform a morphometric analysis of untreated adult skulls displaying syndromic and nonsyndromic craniosynostosis. We analyzed, in detail, 42 adult craniosynostoses (18 scaphocephaly, 11 anterior plagiocephaly, 2 trigonocephaly, 9 oxycephaly, and 2 brachycephaly) from archeological (three skulls) and pathoanatomical samples (39 skulls). The univariate and bivariate measurements from the pathological skulls were compared with 40 anatomical skulls with normal cranial vault morphology. Bony signs of chronic elevated intracranial pressure (ICP) are (1) diffuse beaten copper pattern, (2) dorsum sellae erosion, (3) suture diastasis, and (4) abnormalities of venous drainage that particularly affect the sigmoid-jugular sinus complex. The mean cranial length was significantly greater in scaphocephaly than in anatomical skulls (20.3 vs 18.0 cm), and the sagittal suture was also longer (14.3 vs 11.8 cm). There were three types of suture course in the bregma region in scaphocephaly: anterior spur (28%), normal configuration (61%), and posterior spur (11%). The plagiocephaly measurements showed nonsignificant differences, and there was no correlation between the length of the anterior and middle skull base (ipsilateral anterior-posterior shortening of the skull) and incomplete or complete suture synostosis. Bony signs of chronic elevated ICP were found in 82% of cases of oxycephaly and brachycephaly. In three such cases of oxycephaly, we found a marked (1.8-2.1 cm) elevation of bregma region. One skull (Saethre-Chotzen syndrome) yielded human DNA sufficient for polymerase chain reaction (PCR)-based amplification procedures. Mutation analyses in the FGFR3 gene revealed nucleotide alterations located in the mutational hot spot at amino acid residue 250 (g.C749). The mean cranial length in adult scaphocephaly was 12% greater than anatomical skulls. A unilateral complete or incomplete coronal synostosis can be found with or without plagiocephalic
Estrada, Héctor; Rebling, Johannes; Turner, Jake; Kneipp, Moritz; Shoham, Shy; Razansky, Daniel
The acoustically-mismatched skull bone poses significant challenges for the application of ultrasonic and optical techniques in neuroimaging, still typically requiring invasive approaches using craniotomy or skull thinning. Optoacoustic imaging partially circumvents the acoustic distortions due to the skull because the induced wave is transmitted only once as opposed to the round trip in pulse-echo ultrasonography. To this end, the mouse brain has been successfully imaged transcranially by optoacoustic scanning microscopy. Yet, the skull may adversely affect the lateral and axial resolution of transcranial brain images. In order to accurately characterize the complex behavior of the optoacoustic signal as it traverses through the skull, one needs to consider the ultrawideband nature of the optoacoustic signals. Here the insertion loss of murine skull has been measured by means of a hybrid optoacoustic-ultrasound scanning microscope having a spherically focused PVDF transducer and pulsed laser excitation at 532 nm of a 20 μm diameter absorbing microsphere acting as an optoacoustic point source. Accurate modeling of the acoustic transmission through the skull is further performed using a Fourier-domain expansion of a solid-plate model, based on the simultaneously acquired pulse-echo ultrasound image providing precise information about the skull's position and its orientation relative to the optoacoustic source. Good qualitative agreement has been found between the a solid-plate model and experimental measurements. The presented strategy might pave the way for modeling skull effects and deriving efficient correction schemes to account for acoustic distortions introduced by an adult murine skull, thus improving the spatial resolution, effective penetration depth and overall image quality of transcranial optoacoustic brain microscopy.
Naylor, Kyla L; Zou, Guangyong; Leslie, William D; Hodsman, Anthony B; Lam, Ngan N; McArthur, Eric; Fraser, Lisa-Ann; Knoll, Gregory A; Adachi, Jonathan D; Kim, S Joseph; Garg, Amit X
AIM: To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients. METHODS: We conducted a cohort study of all adults who received a kidney-only transplant (n = 2723) in Ontario, Canada between 2002 and 2009. We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures (proximal humerus, forearm, hip, and clinical vertebral). The final model was established using the backward elimination strategy, selecting risk factors with a P-value ≤ 0.2 and forcing recipient age and sex into the model. We also assessed risk factors for other fracture locations (excluding major fractures, and fractures involving the skull, hands or feet). RESULTS: There were 132 major fractures in the follow-up (8.1 fractures per 1000 person-years). General risk factors associated with a greater risk of major fracture were older recipient age [adjusted hazard ratio (aHR) per 5-year increase 1.11, 95%CI: 1.03-1.19] and female sex (aHR = 1.81, 95%CI: 1.28-2.57). Transplant-specific risk factors associated with a greater risk of fracture included older donor age (5-year increase) (aHR = 1.09, 95%CI: 1.02-1.17) and end-stage renal disease (ESRD) caused by diabetes (aHR = 1.72, 95%CI: 1.09-2.72) or cystic kidney disease (aHR = 1.73, 95%CI: 1.08-2.78) (compared to glomerulonephritis as the reference cause). Risk factors across the two fracture locations were not consistent (major fracture locations vs other). Specifically, general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation, while length of time on dialysis, and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures. CONCLUSION: Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant
Ben, Y.; Wang, Y.; Shi, G.
Hydraulic Fracturing has been used successfully in the oil and gas industry to enhance oil and gas production in the past few decades. Recent years have seen the great development of tight gas, coal bed methane and shale gas. Natural fractures are believed to play an important role in the hydraulic fracturing of such formations. Whether natural fractures can benefit the fracture propagation and enhance final production needs to be studied. Various methods have been used to study the effect of natural fractures on hydraulic fracturing. Discontinuous Deformation Analysis (DDA) is a numerical method which belongs to the family of discrete element methods. In this paper, DDA is coupled with a fluid pipe network model to simulate the pressure response in the formation during hydraulic fracturing. The focus is to study the effect of natural fractures on hydraulic fracturing. In particular, the effect of rock joint properties, joint orientations and rock properties on fracture initiation and propagation will be analyzed. The result shows that DDA is a promising tool to study such complex behavior of rocks. Finally, the advantages of disadvantages of our current model and future research directions will be discussed.
Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael
The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.
Stenfelt, S P; Håkansson, B E
A miniaturized artificial mastoid of size and weight that allow calibration and measurement of bone conduction hearing aids in a conventional audiometric soundproof box has been developed. Its level of mechanical impedance corresponds to the standard IEC 373 (1990) within the frequency range 250 Hz to 8 kHz. The miniaturized artificial mastoid consists of three parts: coupler, skull simulator (TU-1000), and an external electrical correction filter. The coupler is a highly damped mass-spring system designed to give the miniaturized artificial mastoid mechanical impedance in accordance with the standard IEC 373 (1990). It was found that the miniaturized artificial mastoid yielded results that are in correspondence with results obtained with the Brüel & Kjaer type 4930 artificial mastoid for frequencies above 450 Hz. Thus, at these frequencies, the miniaturized artificial mastoid can be used for audiometer calibration as well as measurement of bone conduction hearing aids.
Severino, Mariasavina; Liyanage, Sidath; Novelli, Vas; Cheesborough, Beth; Saunders, Dawn; Gunny, Roxana; Rossi, Andrea
Skull base osteomyelitis is an aggressive, life-threatening infection that can be challenging to diagnose and treat. It occurs predominantly in elderly immunocompromised patients, but it has also been reported in children with normal immunological status. Typical skul base osteomyelitis arises as a complication to ear infection mainly involving the temporal bone and is usually caused by Pseudomonas aeruginosa. Atypical or central skul base osteomyelitis originates from paranasal infections, is primarily centred on the clivus and is usually caused by Aspergillus, Pseudomonas, Salmonella or Staphylococcus species. Potential complications include retropharyngeal abscesses, cranial neuropathies, meningitis, intracranial abscesses, sinovenous thrombosis, and carotid artery involvement with or without ischemic infarcts. The purpose of this pictorial essay is to illustrate the spectrum of imaging findings and potential complications of skul base osteomyelitis.
Çorumlu, Ufuk; Demir, Mehmet Tevfik; Pirzirenli, Mennan Ece
Elongation or hyperplasia of coronoid process of mandible is rare condition characterized by abnormal bone development which cause malocclusion and the limited mouth opening. In this study, in an Anatolian skull, a case of bilateral elongation of mandibular coronoid process was presented. Levandoski panographic analysis was performed on the panoramic radiographie to determine the hyperplasia of the coronoid process. The right condylar process was exactly hyperplastic. The measurements of Kr-Go/Cd-Go were 95.10 mm/79.03 mm on right side and 97.53 mm/87.80 mm on left side. The ratio of Kr-Go/Cd-Go on the right side was 1.20. Elongated coronoid process is one of the factors cause mandibular hypomobility, it as reported here might lead to limited mouth opening. The knowledge of this variation or abnormality can be useful for the radiologist and surgeons and prevent misdiagnosis. PMID:27722017
Fetterman, B L; Lanman, T H; House, J W
Headache after skull base surgery can cause profound morbidity in certain patients, resulting in significant impairment of their quality of life. Several methods to prevent postoperative headache have been described, including a modification of the skin/muscle incision replacing the craniotomy bone flap replacing the bone flap and filling in the residual defect with methyl methacrylate, using hydroxyapatite cement (HAC) to fill the craniectomy defect, and wiring hardened methyl methacrylate (MMA) into the defect. Ten patients with severe headache following craniectomy for a posterior fossa lesion underwent cranioplasty with MMA, which was placed exactly within the craniectomy defect and secured rigidly with miniplates and screws. The headache decreased in severity in all patients and resolved completely in 90%. Also, 78% of patients with dizziness improved. The procedure and its effect on headache and dizziness will be described.
Gabriel, S E; Tosteson, A N A; Leibson, C L; Crowson, C S; Pond, G R; Hammond, C S; Melton, L J
Osteoporotic fractures are a major cause of morbidity in the elderly, the most rapidly growing segment of our population. We characterized the incremental direct medical costs following such fractures in a population-based cohort of men and women in Olmsted County, Minnesota. Cases included all County residents 50 years of age and older with an incident fracture due to minimal or moderate trauma between January 1, 1989 and January 1, 1992. For each case, a control of the same age (+/- 1 year) and sex who was attended in the local medical system in the same year was identified. Total incremental costs (cases - controls) in the year after fracture were estimated. Unit costs for each health service/procedure were obtained through the Mayo Cost Data Warehouse, which provides a standardized, inflation-adjusted estimate reflecting the national average cost of providing the service. Regression analysis was used to identify factors associated with incremental costs. There were 1263 case/control pairs; their average age was 73.8 years and 78% were female. Median total direct medical costs were $761 and $625, respectively, for cases and nonfracture controls in the year prior to fracture, and $3884 and $712, respectively, in the year following fracture. The highest median incremental costs were for distal femur ($11756) and hip fractures ($11241), whereas the lowest were for rib fractures ($213). Although hip fractures resulted in more incremental cost than any other fracture type, this amounted to only 37% of the total incremental cost of all moderate-trauma fractures combined. Regression analyses revealed that age, prior year costs and type of fracture were significant predictors of incremental costs (p<0.03 for all comparisons). The incremental costs of osteoporotic fractures are therefore substantial. Whereas hip fractures contributed disproportionately, they accounted for only one-third of the total incremental cost of fractures in our cohort. The use of incremental
Wang, Liang; Tian, Kaibing; Wang, Ke; Ma, Junpeng; Ru, Xiaojuan; Du, Jiang; Jia, Guijun; Zhang, Liwei; Wu, Zhen; Zhang, Junting
Skull base chordoma is a rare and fatal disease, recurrence of which is inevitable, albeit variable. We aimed to investigate the clinicopathologic features of disease progression, identify prognostic factors, and construct a nomogram for predicting progression in individual patients. Data of 229 patients with skull base chordoma treated by one institution between 2005 and 2014 were retrieved and grouped as primary and recurrent. Kaplan-Meier survival of progression was estimated, taking competing risks into account. Multivariable Cox regression was used to investigate survival predictors. The primary group consisted by 183 cases, gained more benefits on 5-year progression-free survival (PFS) (51%) and mean PFS time (66.9 months) than the recurrent group (46 cases), in which 5-year postrecurrent PFS was 14%, and mean postrecurrent PFS time was 29.5 months. In the primary group, visual deficits, pathological subtypes, extent of bone invasion, preoperative Karnofsky performance scale (KPS) score, and variation in perioperative KPS were identified as independent predictors of PFS. A nomogram to predict 3-year and 5-year PFS consisted of these factors, was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.68). In the recurrent group, marginal resection (P = 0.018) and adjuvant radiotherapy (P = 0.043) were verified as protective factors associated with postrecurrent PFS. Factors for tumor progression demonstrated some differences between primary and recurrent cases. The nomogram appears useful for risk stratification of tumor progression in primary cases. Further studies will be necessary to identify the rapid-growth histopathological subtype as an independent predictor of rapid progression.
Berliner, Elihay; Bar Meir, Maskit; Megged, Orli
Bacterial meningitis is a life threatening disease. Most patients will experience only one episode throughout life. Children who experience bacterial meningitis more than once, require further immunologic or anatomic evaluation. We report a 9 year old child with five episodes of bacterial meningitis due to a congenital defect of the skull base. A two and a half year old boy first presented to our medical center with pneumococcal meningitis. He was treated with antibiotics and fully recovered. Two months later he presented again with a similar clinical picture. Streptococcus pneumoniae grew in cerebrospinal fluid (CSF) culture. CT scan and later MRI of the brain revealed a defect in the anterior middle fossa floor, with protrusion of brain tissue into the sphenoidal sinus. Corrective surgery was recommended but the parents refused. Three months later, a third episode of pneumococcal meningitis occurred. The child again recovered with antibiotics and this time corrective surgery was performed. Five years later, the boy presented once again with clinical signs and symptoms consistent with bacterial meningitis. CSF culture was positive, but the final identification of the bacteria was conducted by broad spectrum 16S ribosomal RNA PCR (16S rRNA PCR) which revealed a sequence of Neisseria lactamica. CT and MRI showed recurrence of the skull base defect with encephalocele in the sphenoid sinus. The parents again refused neurosurgical intervention. A year later the patient presented with bacterial meningitis. CSF culture obtained after initiation of antibiotics was negative, but actinobacillus was identified in the CSF by 16S rRNA PCR. The patient is scheduled for neurosurgical intervention. In patients with recurrent bacterial meningitis caused by organisms colonizing the oropharynx or nasopharynx, an anatomical defect should be carefully sought and surgically repaired.
Tsuyumu, M; Fujiwara, K; Yamaguchi, T; Hiratsuka, H; Inaba, Y
Twenty-three cases suspected of skull base tumors were examined by CT cisternography (CTC) with CT scanner (EMI 1010) from April, 1977 to March, 1978. The lesions in 20 cases were diagnosed as positive and confirmed by operation and/or autopsies. These include five acoustic neurinomas, six pituitary adenomas, two craniopharyngiomas, two skull base meningiomas, one arachnoid cyst and miscellaneous tumors. Isotonic Metrizamide solution four of 2-10 ml was injected via lumbar route. Patients were kept in 30 degrees Trendelenburg position for 60 minutes until the first scanning. Scannings were obtained 1, 3, 6, 24 and in some cases 48 hours after lumbar injection. No side effects except for headache, nausea, vomiting occurred. There were no convulsions. In diagnosing cerebellopontine angle tumors, the indirect signs such as asymmetrical ambient cisterns are of importance, when combined with direct signs, i.e. a shadow defect. Parasellar tumors are usually difficult to diagnose with conventional CT due to streak artifact caused by adjacent bony structure. In CTC the extrasellar extension of pituitary tumors were clearly visible. The size, shape, dimensions and the relationship to the adjacent structures of the craniopharyngiomas were easily demonstrated with CTC especially when a coronal view was added. In arachnoid cyst, CTC demonstrated the delayed turnover of Metrizamide between the cyst cavity and the adjacent subarachnoid space. In conclusion, CTC is an useful neuroradiological diagnostic adjunct because of minimal bony streak artifact and high spatial resolution. It would be expected that small tumors of even 2-3 mm in diameter might be diagnosed, from the fact that the middle cerebral artery in the suprasellar cistern is clearly visible as a shadow defect.
Sejrsen, B; Lynnerup, N; Hejmadi, M
The Institute of Forensic Medicine, Copenhagen, houses a collection of historical skulls of unclear origin, marked with a general geographic or "racial descriptor". Would these historical skulls be of any value for the forensic odontologist and anthropologist concerned with teaching and casework? We tried to clarify this question by recording non-metric dental traits and by performing craniometric analyses. A morphological and morphometric investigation of anatomical/dental traits in 80 adult skulls was performed. For each skull four non-metric dental traits using the ASU-System and three non-metric cranial traits were recorded. Nineteen cranial measures were also taken following the FORDISC programme manual. The non-metrical data were tabulated as frequencies, and the metric data were entered in the FORDISC programme. Observed non-metric trait frequencies were compared with published data. The FORDISC programme computed a discriminatory analysis for each skull and thereby assigned the skull to the most probable ethnic category. The results for the non-metric traits showed that the traits generally followed the expected frequencies in 80% of the cases. The FORDISC programme correctly assigned ethnicity based on skull measurements in overall 70% of the cases. It was found that this historical collection does show expected dental non-metric and craniometric traits and the collection may be of value in forensic casework in terms of comparison and for teaching purposes.
Hayner, Mark; Hynynen, Kullervo
Ultrasonic transmission and absorption of oblique plane waves through the human skull are analyzed numerically for frequencies ranging from 1/2 to 1 MHz. These frequencies are optimum for noninvasive ultrasound therapy of brain disorders where numerical predictions of skull transmission are used to set the phase and amplitude of source elements in the phased array focusing system. The idealized model of the skull is a three-layer solid with ivory outer and inner layers and a middle marrow layer. Each layer is modeled as a flat, homogeneous, isotropic, linear solid with effective complex wave speeds to account for focused energy losses due to material damping and scattering. The model is used to predict the amplitude and phase of the transmitted wave and volumetric absorption. Results are reported for three different skull thicknesses: 3 mm, 6 mm, and 9 mm. Thickness resonances are observed in the transmitted wave for 3 mm skulls at all frequencies and for the 6 mm skulls below 0.75 MHz. Otherwise, the transmission is dominated by the direct wave. Skull phase errors due to shear waves are shown to minimally degrade the power at the focus for angles of incidence up to 20° from normal even for low material damping. The location of the peak volumetric absorption occurs either in the outer ivory or middle marrow layer and shown to vary due to wave interference.
Tang, Chi; You, Fusheng; Cheng, Guang; Gao, Dakuan; Fu, Feng; Dong, Xiuzhen
An accurate impedance model of a skull plays an important role in the simulation research on source localization of EEG and brain EIT (electrical impedance tomography), etc. On the basis of the large number of impedance and resistivity data obtained from our previous measurement on the live human skull, in this study we established the equivalent circuit models of six types of skull samples in the 30 Hz-3 MHz frequency range and analyzed the fitting performance of the models. The six types of skull samples are standard tri-layer, quasi-tri-layer, standard compact, quasi-compact, dentate suture and squamous suture. The results showed that the difference of the real part between the CPE (constant phase model) model and the measured data was less than 1% for all skull tissue types when the optimized characteristic parameters (rho(0), rho(infinity), alpha and f(c)) were adopted in the model. It is the first time studying the impedance model of different types of skulls, and it may provide accurate modeling of the skull to improve the accuracy of the related research on bioelectricity of the head and the biological effects of the electromagnetic field.
Fenton, Todd W; Heard, Amber N; Sauer, Norman J
We report on the application of video skull-photo superimposition as an identification method in a case from Ajo, Arizona in which five individuals died after crossing into southern Arizona from Mexico. Initial analyses at the Pima County Forensic Science Center in Tucson, Arizona determined that the disarticulated skeletal remains represented two adult Hispanic males and three adult Hispanic females. Based on biological profiles, both the males and one of the females were tentatively identified and assigned names. The other two females were too similar in age and height, making skeletal separation and identification difficult. As a result, the Michigan State University Forensic Anthropology Laboratory assisted in the identification efforts by performing video skull-photo superimposition on the two unknown females. The skulls were compared to a photograph reported to be one of the missing females. By evaluating facial proportionality and by comparing a number of morphological features of the face and skulls, one skull was excluded as a possible match and one skull was not excluded as a match to the antemortem photo. Because this case was presumed to be a closed disaster, the exclusion of one skull and the failure to exclude the other represented circumstantial identifications.
Ramamoorthy, Balakrishnan; Pai, Mangala M; Prabhu, Latha V; Muralimanju, B V; Rai, Rajalakshmi
The skeleton plays an important role in sex determination in forensic anthropology. The skull bone is considered as the second best after the pelvic bone in sex determination due to its better retention of morphological features. Different populations have varying skeletal characteristics, making population specific analysis for sex determination essential. Hence the objective of this investigation is to obtain the accuracy of sex determination using cranial parameters of adult skulls to the highest percentage in South Indian population and to provide a baseline data for sex determination in South India. Seventy adult preserved human skulls were taken and based on the morphological traits were classified into 43 male skulls and 27 female skulls. A total of 26 craniometric parameters were studied. The data were analyzed by using the SPSS discriminant function. The analysis of stepwise, multivariate, and univariate discriminant function gave an accuracy of 77.1%, 85.7%, and 72.9% respectively. Multivariate direct discriminant function analysis classified skull bones into male and female with highest levels of accuracy. Using stepwise discriminant function analysis, the most dimorphic variable to determine sex of the skull, was biauricular breadth followed by weight. Subjecting the best dimorphic variables to univariate discriminant analysis, high levels of accuracy of sexual dimorphism was obtained. Percentage classification of high accuracies were obtained in this study indicating high level of sexual dimorphism in the crania, setting specific discriminant equations for the gender determination in South Indian people.
Chen, Z; Qiu, Q H; Zhan, J B; Zhu, Z C; Peng, Y; Liu, H
Objective: To investigate the clinical efficacy of endoscopic surgery for extensive osteoradionecrosis (ORN) of skull base in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: Seventeen patients diagnosed as ORN of skull base after radiotherapy for NPC and underwent endoscopic surgery were retrospectively studied with their clinic data. Results: Based on the CT and endoscopic examination, all patients had large skull base defects with bone defects averaged 7.02 cm(2) (range, 3.60 - 14.19 cm(2)). Excepting for curetting the sequestra, endoscopic surgery was also used to repair the wound or to protect the internal carotid artery with flap in 12 patients. No bone reconstructions were conducted in all patients with the bone defects of skull base. CT examinations were taken after endoscopic surgery when required. The postoperative follow-up ranged from 8 months to 6 years (average, 14 months). Aside from 1 patient with delayed cerebrospinal fluid (CSF), others had no related complications. Conclusions: The patients with extensive ORN can be treated with endoscopic surgery to curette the necrotic bone of skull base, and endoscopic reconstruction provides an alternative technique. It may not be necessary to reconstruct the bone defects at skull base, however, the exposed important structures of skull base, such as internal carotid artery, need to repair with soft tissue such as flap.
Cvijanović, Milena; Ivanović, Ana; Kalezić, Miloš L; Zelditch, Miriam L
Comparative studies of ontogenies of closely related species provide insights into the mechanisms responsible for morphological diversification. Using geometric morphometrics, we investigated the ontogenetic dynamics of postlarval skull shape and disparity in three closely related crested newt species. The skull shapes of juveniles just after metamorphosis (hereafter metamorphs) and adult individuals were sampled by landmark configurations that describe the shape of the dorsal and ventral side of the newt skull, and analyzed separately. The three species differ in skull size and shape in metamorphs and adults. The ontogenies of dorsal and ventral skull differ in the orientation but not lengths of the ontogenetic trajectories. The disparity of dorsal skull shape increases over ontogeny, but that of ventral skull shape does not. Thus, modifications of ontogenetic trajectories can, but need not, increase the disparity of shape. In species with biphasic life-cycles, when ontogenetic trajectories for one stage can be decoupled from those of another, increases and decreases in disparity are feasible, but our results show that they need not occur.
Wang, J.; Zhang, Y.; Xu, T. H.; Luo, Q. M.; Zhu, D.
Noninvasive optical methods for viewing the structural and functional organization of cortex have been playing important roles in brain research, which usually suffer from turbid skull. Various cranial window models based on surgical operation have been proposed, but have respective limitations. Here, an innovative transparent cranial window of mouse was established by topically treatment with a skull optical clearing solution (SOCS), rather than by craniotomy. Based on the experiment of optical clearing efficacy of skull in vitro, we found that the turbid skull became transparent within 25 min after application of SOCS. The USAF target is visible through the treated skull, and the calculated resolution can achieve 8.4 μm. After the in vivo skull was topically treated with SOCS, the cortical micro-vessels can be visible clearly. The quantitative analysis indicated that the minimum resolution diameter of micro-vessels in 14.4±0.8 μm through the transparent cranial window closed to that in 12.8±0.9 μm of the exposed cortical micro-vessels. Further, preliminary results from Laser Speckle Imaging demonstrated that there was no influence on cortical blood flow distribution of mouse after topically treatment with SOCS on skull. This transparent cranial window will provide a convenient model for cortex imaging in vivo, which is very significant for neuroscience research.
Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G
In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.
Nakazawa, Hisato; Komori, Masataka; Mori, Yoshimasa; Hagiwara, Masahiro; Shibamoto, Yuta; Tsugawa, Takahiko; Hashizume, Chisa; Kobayashi, Tatsuya
In treatment planning of Leksell Gamma Knife (LGK) radiosurgery, the skull geometry defined by generally dedicated scalar measurement has a crucial effect on dose calculation. The LGK Perfexion (PFX) unit is equipped with a cone-shaped collimator divided into eight sectors, and its configuration is entirely different from previous model C. Beam delivery on the PFX is made by a combination of eight sectors, but it is also mechanically available from one sector with the remaining seven blocked. Hence the treatment time using one sector is more likely to be affected by discrepancies in the skull shape than that of all sectors. In addition, the latest version (Ver. 10.1.1) of the treatment planning system Leksell GammaPlan (LGP) includes a new function to directly generate head surface contouring from computed tomography (CT) images in conjunction with the Leksell skull frame. This paper evaluates change of treatment time induced by different skull models. A simple simulation using a uniform skull radius of 80 mm and anthropomorphic phantom was implemented in LGP to find the trend between dose and skull measuring error. To evaluate the clinical effect, we performed an interobserver comparison of ruler measurement for 41 patients, and compared instrumental and CT-based contours for 23 patients. In the phantom simulation, treatment time errors were less than 2% when the difference was within 3 mm. In the clinical cases, the variability of treatment time induced by the differences in interobserver measurements was less than 0.91%, on average. Additionally the difference between measured and CT-based contours was good, with a difference of -0.16% ± 0.66% (mean ±1 standard deviation) on average and a maximum of 3.4%. Although the skull model created from CT images reduced the dosimetric uncertainty caused by different measurers, these results showed that even manual skull measurement could reproduce the skull shape close to that of a patient's head within an acceptable
Kunz, Christoph; Audigé, Laurent; Cornelius, Carl-Peter; Buitrago-Téllez, Carlos H.; Frodel, John; Rudderman, Randal; Prein, Joachim
The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 system for the midface unit that concentrates on the location of the fractures within defined regions in the central (upper, intermediate, and lower) and lateral (zygoma, pterygoid) midface, as well as the internal orbit and palate. The level 2 midface fracture location outlines the topographic boundaries of the anatomical regions. The common nasoorbitoethmoidal and zygoma en bloc fracture patterns, as well as the time-honored Le Fort classification are taken into account. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical cranial midface regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification. Individual fracture mapping in these regions regarding severity, fragmentation, displacement of the fragment or bone defect is addressed in a more detailed level 3 system in the subsequent articles. PMID:25489391
Hofer, M; Dittrich, E; Scholl, C; Neumuth, T; Strauss, M; Dietz, A; Lüth, T; Strauss, G
Surgery on the lateral skull base puts delicate structures at risk. To support the surgeon in identifying and protecting the risk structures the principle of Navigated Control (NC) can be used for preventing iatrogenic injuries. In this paper the application of Navigated Control for surgery on the lateral skull base was investigated for the first time in clinical use. There was no risk structure damage with NC. Navigated Control in lateral skull base surgery seems to have a great potential for safe risk structure protection, a morbidity reduction and in a relief of strain for the surgeon.
Zanatta, Alberto; Scattolin, Giuliano; Thiene, Gaetano; Zampieri, Fabio
The University of Padua has many legends about its cultural heritage. One of these concerns a collection of eight skulls still preserved in the Hall of Medicine at Bo Palace, near the old anatomy theatre built in 1545. It is said that some famous professors of the University donated their bodies to medical science, and the skulls were from these bodies. From multidisciplinary research, both historical and anthropological, we have discovered that Francesco Cortese, Professor of Medicine and Rector of the University, started this personal collection of colleagues' skulls, although they had not donated their bodies to science, so that he could make his own detailed phrenology study.
The article focuses on a rare example of a miniature skull of unknown origin. The profoundness of the anatomical details, conjoint with outstanding virtuosity, reminds of Leonardo da Vinci's anatomical skull studies and asks for additional interpretation beside the emblematic "memento mori"-character. Following the miscellaneous topics of his skull studies an anatomical-anthropological interpretation is proposed. For such a project the mergence of anthropology, history of medicine and history of art was mandatory. Concerning some discrepancies within the anatomical realism, the depiction of a pathology is discussed and beyond the visualisation of a historic concept of brain function.
Venkata, Suman; Shaik, Sameulla; Kodadala, Amrutha; Kakarla, Prashanti
Eosinophilic granuloma is basically a disorder of reticuloendothelial system and is one of the variants of langerhans cell histiocytosis. Multifocal eosinophilic granuloma affecting jaws and skull is relatively a rare disorder. We hereby report a case of multifocal eosinophilic granuloma involving mandible, maxilla and several skull bones. The present case has mixture of classical floating teeth appearance and an unusual radiographic/imaging finding of periosteal remodeling, which is rarely seen in adult patients of eosinophilic granuloma and pseudo-multilocular appearance in anterior mandibular region in coronal sections and moth-eaten appearance of skull was appreciated in axial slices of Computed Tomography (CT). PMID:28274065
Volk, Carina; Huber, Reto
Sleep is undisputable an essential part of our life, if we do not sleep enough we feel the consequences the next day. The importance of sleep for healthy brain functioning has been well studied in adults, but less is known for the role of sleep in the paediatric age. Childhood and adolescence is a critical phase for brain development. The increased need for sleep during this developmental phase fosters the growing recognition for a central role of sleep during development. In this review we summarize the findings that demonstrate a close relationship between sleep and brain maturation, discuss the consequences of insufficient sleep during childhood and adolescence and outline initial attempts that have been made in order to improve sleep in this age range.
Basu, N.; Pryor, R.J.
This report presents a microsimulation model of a transition economy. Transition is defined as the process of moving from a state-enterprise economy to a market economy. The emphasis is on growing a market economy starting from basic microprinciples. The model described in this report extends and modifies the capabilities of Aspen, a new agent-based model that is being developed at Sandia National Laboratories on a massively parallel Paragon computer. Aspen is significantly different from traditional models of the economy. Aspen`s emphasis on disequilibrium growth paths, its analysis based on evolution and emergent behavior rather than on a mechanistic view of society, and its use of learning algorithms to simulate the behavior of some agents rather than an assumption of perfect rationality make this model well-suited for analyzing economic variables of interest from transition economies. Preliminary results from several runs of the model are included.
Young, Ki Won; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai
Background We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Methods Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. Results The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Conclusions Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were
Fractures of the forefoot are common and comprise approximately two thirds of all foot fractures. Forefoot fractures are caused by direct impact or the effect of indirect force. The forces exerted can range from repetitive minor load (stress fractures) to massive destructive forces (complex trauma). The clinical course in forefoot fractures is typically more favourable than in fractures of the mid- and hindfoot. The incidence of complications like infection or pseudarthrosis is low. Exceptions are rare fractures of the proximal shaft of the fifth metatarsal and the sesamoids with higher pseudarthrosis rates. Malunited metatarsal fractures can cause painful conditions that should even be treated operatively. Differences in structure and function of the different forefoot areas and specific fracture types require an adapted management of these special injuries.
McNemar, Thomas B; Howell, Julianne Wright; Chang, Eric
Fractures of the hand are the most common fractures of the human skeleton. Metacarpal fractures account for 30% to 50% of all of hand fractures. The mechanisms of these injuries vary from axial loading forces to direct blows to the dorsal hand. Resulting deformities include malrotation, angulation, and shortening. Treatment modalities vary from nonoperative reduction to open reduction and internal fixation. The treatment algorithm is guided by the location of the fracture, the stability of the fracture, and the resultant deformity. Operative procedures, although they may lead to excellent radiographic reduction of fractures, often lead to debilitating stiffness from the inflammatory reaction of the surgical procedure. Operative fixation must be employed judiciously and offered only when confident that non-operative therapy can be improved on with operative intervention. This article reviews the various types of metacarpal fractures, with the treatment options available for each fracture. The indications for each treatment modality, postoperative care, and rehabilitation are presented.
Audigé, Laurent; Cornelius, Carl-Peter; Di Ieva, Antonio; Prein, Joachim
Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.
Audigé, Laurent; Cornelius, Carl-Peter; Ieva, Antonio Di; Prein, Joachim
Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal. PMID:25489387
Kremnev, L. S.
Based on the nonlinear mechanics of material fracture, a model of the fracture of materials with actual (discrete) structures has been constructed. The model is supported by proofs that crack resistance K 1 c and fracture toughness G 1 c obtained from the energy conservation law without using the assumptions adopted in the linear material fracture mechanics serve as the force and energy criteria in the nonlinear fracture mechanics. It has been shown that energy criterion G 1 c in the nonlinear mechanics is much greater than G 1 c in the linear fracture mechanics.
Catts, Oron; Zurr, Ionat
Tissue engineering and regenerative biology are usually discussed in relation to biomedical research and applications. However, hand in hand with developments of this field in the biomedical context, other approaches and uses for non-medical ends have been explored. There is a growing interest in exploring spin off tissue engineering and regenerative biology technologies in areas such as consumer products, art and design. This paper outlines developments regarding in vitro meat and leather, actuators and bio-mechanic interfaces, speculative design and contemporary artistic practices. The authors draw on their extensive experience of using tissue engineering for non-medical ends to speculate about what lead to these applications and their possible future development and uses. Avoiding utopian and dystopian postures and using the notion of the contestable, this paper also mentions some philosophical and ethical consideration stemming from the use of non-medical approaches to tissue constructs. This article is part of a directed issue entitled: Regenerative Medicine: the challenge of translation.
Straathof, C S M; Doorenweerd, N; Wokke, B H A; Dumas, E M; van den Bergen, J C; van Buchem, M A; Hendriksen, J G M; Verschuuren, J J G M; Kan, H E
Muscle hypertrophy and muscle weakness are well known in Duchenne muscular dystrophy. Decreased muscle force can have secondary effects on skeletal growth and development such as facial and dental morphology changes. In this study, we quantified temporal muscle thickness, circumference, and eccentricity of the skull and the head on T1-weighted magnetic resonance imaging (MRI) scans of the head of 15 Duchenne muscular dystrophy patients and 15 controls. Average temporal muscle thickness was significantly increased in patients (12.9 ± 5.2 mm) compared to controls (6.8 ± 1.4 mm) (P < .0001), whereas the shape of the skull was significantly rounder compared to controls. Temporal muscle thickness and skull eccentricity were significantly negatively correlated in patients, and positively in controls. Hypertrophy of the temporal muscles and changes in skull eccentricity appear to occur early in the course of Duchenne muscular dystrophy. Further studies in younger patients are needed to confirm a causal relationship.
Buffetaut, E.; Grigorescu, D.; Csiki, Z.
A new giant pterosaur, Hatzegopteryx thambema, nov.gen., nov.sp., from the Maastrichtian Densuş-Ciula Formation of Romania is remarkable for its very large size (estimated wing span >=12 m) and for the robustness of its large skull, which may have been nearly 3 m long. The stout skull bones contrast with the usually thin and slender skull elements of other pterosaurs, and raise the question of how the weight of the skull was reduced in order to make flight possible. The answer probably lies in the very peculiar internal structure of the bones, which consists of a dense network of very thin trabeculae enclosing small alveoli. This structure is reminiscent of expanded polystyrene and, like it, probably combined strength with lightness.
Buffetaut, E; Grigorescu, D; Csiki, Z
A new giant pterosaur, Hatzegopteryx thambema, nov.gen., nov.sp., from the Maastrichtian Densuş-Ciula Formation of Romania is remarkable for its very large size (estimated wing span > or = 12 m) and for the robustness of its large skull, which may have been nearly 3 m long. The stout skull bones contrast with the usually thin and slender skull elements of other pterosaurs, and raise the question of how the weight of the skull was reduced in order to make flight possible. The answer probably lies in the very peculiar internal structure of the bones, which consists of a dense network of very thin trabeculae enclosing small alveoli. This structure is reminiscent of expanded polystyrene and, like it, probably combined strength with lightness.
Gui, Meng; Song, Juyi; Zhang, Lu; Wang, Shun; Wu, Ruiyun; Ma, Changwei; Li, Pinglan
Chondroitin sulfates (CSs) were extracted from sturgeon skull and backbone, and their chemical composition, anticoagulant, anti-platelet and thrombolysis activities were evaluated. The average molecular weights of CS from sturgeon skull and backbone were 38.5kDa and 49.2kDa, respectively. Disaccharide analysis indicated that the sturgeon backbone CS was primarily composed of disaccharide monosulfated in position four of the GalNAc (37.8%) and disaccharide monosulfated in position six of the GalNAc (59.6%) while sturgeon skull CS was primarily composed of nonsulfated disaccharide (74.2%). Sturgeon backbone CS showed stronger antithrombotic effect than sturgeon skull CS. Sturgeon backbone CS could significantly prolong activated partial thromboplastin time (APTT) and thrombin time (TT), inhibited ADP-induced platelet aggregation and dissolved platelet plasma clots in vitro. The results suggested that sturgeon backbone CS can be explored as a functional food with antithrombotic function.
Porro, Laura B; Witmer, Lawrence M; Barrett, Paul M
Several skulls of the ornithischian dinosaur Lesothosaurus diagnosticus (Lower Jurassic, southern Africa) are known, but all are either incomplete, deformed, or incompletely prepared. This has hampered attempts to provide a comprehensive description of skull osteology in this crucial early dinosaurian taxon. Using visualization software, computed tomographic scans of the Lesothosaurus syntypes were digitally segmented to remove matrix, and identify and separate individual cranial and mandibular bones, revealing new anatomical details such as sutural morphology and the presence of several previously undescribed elements. Together with visual inspection of exposed skull bones, these CT data enable a complete description of skull anatomy in this taxon. Comparisons with our new data suggest that two specimens previously identified as Lesothosaurus sp. (MNHN LES 17 and MNHN LES 18) probably represent additional individuals of Lesothosaurus diagnosticus.
Yucha, Josephine M; Pokines, James T; Bartelink, Eric J
Cranial remains retained from fallen enemies are commonly referred to as "trophy skulls," and many such crania were acquired as souvenirs by U.S. servicemembers during WWII and the Vietnam conflict. These remains increasingly have become the subject of forensic anthropological analysis as their possessors, typically veterans or their relatives, try to discard or repatriate them. The present research uses a qualitative analytical approach to review 24 cases of reported trophy skulls (14 previously unpublished cases and 10 from the literature) to determine which perimortem and postmortem characteristics are most useful for generating a taphonomic profile. Overall, the taphonomic signature of trophy remains includes traits relating to acquisition and preparation, ornamental display, and subsequent curation. Contextual evidence and the biological profile also are considered when determining the possible origin of human cranial remains as a trophy skull. Thorough taphonomic analysis will aid in identifying these types of remains as trophy skulls.
Krengli, Marco; Apicella, Giuseppina; Deantonio, Letizia; Paolini, Marina; Masini, Laura
Aim A literature review was performed to analyse the role of stereotactic radiotherapy given in a single shot or in a fractionated fashion for recurrent skull base tumours in order to ascertain if it can be a real salvage approach. Background The management of recurrent skull base tumours can have a curative or palliative intent and mainly includes surgery and RT. Materials and methods One-thousand-ninety-one articles were found in the search databases and the most relevant of them were analysed and briefly described. Results Data on recurrences of meningioma, pituitary adenoma, craniopharyngioma, chordoma and chondrosarcoma, vestibular schwannoma, glomus jugulare tumours, olfactory neuroblastoma and recurrences from head and neck tumours invading the base of skull are reported highlighting the most relevant results in terms of local control, survival, side effects and complications. Conclusions In conclusion, it emerges that SRS and FSRT are effective and safe radiation modalities of realize real salvage treatment for recurrent skull base tumours. PMID:26696783
Witmer, Lawrence M.; Barrett, Paul M.
Several skulls of the ornithischian dinosaur Lesothosaurus diagnosticus (Lower Jurassic, southern Africa) are known, but all are either incomplete, deformed, or incompletely prepared. This has hampered attempts to provide a comprehensive description of skull osteology in this crucial early dinosaurian taxon. Using visualization software, computed tomographic scans of the Lesothosaurus syntypes were digitally segmented to remove matrix, and identify and separate individual cranial and mandibular bones, revealing new anatomical details such as sutural morphology and the presence of several previously undescribed elements. Together with visual inspection of exposed skull bones, these CT data enable a complete description of skull anatomy in this taxon. Comparisons with our new data suggest that two specimens previously identified as Lesothosaurus sp. (MNHN LES 17 and MNHN LES 18) probably represent additional individuals of Lesothosaurus diagnosticus. PMID:26713245
Mathur, Ankit; Kesavadas, C; Thomas, Bejoy; Kapilamoorthy, TR
Imaging plays a vital role in evaluation of skull base pathologies as this region is not directly accessible for clinical evaluation. Computerized tomography (CT) and magnetic resonance imaging (MRI) have played complementary roles in the diagnosis of the various neoplastic and non-neoplastic lesions of the skull base. However, CT and conventional MRI may at times be insufficient to correctly pinpoint the accurate diagnosis. Advanced MRI techniques, though difficult to apply in the skull base region, in conjunction with CT and conventional MRI can however help in improving the diagnostic accuracy. This article aims to highlight the importance of advanced MRI techniques like diffusion-weighted imaging, susceptibility-weighted imaging, perfusion-weighted imaging, and MR spectroscopy in differentiation of various lesions involving the skull base. PMID:26427895
Noohi, Fatemeh; Kinnaird, Catherine; Wood, Scott; Bloomberg, Jacob; Mulavara, Ajitkumar; Seidler, Rachael
The aim of the current study was to characterize the brain activation in response to two modes of vestibular stimulation: skull tap and auditory tone burst. The auditory tone burst has been used in previous studies to elicit saccular Vestibular Evoked Myogenic Potentials (VEMP) (Colebatch & Halmagyi 1992; Colebatch et al. 1994). Some researchers have reported that airconducted skull tap elicits both saccular and utricle VEMPs, while being faster and less irritating for the subjects (Curthoys et al. 2009, Wackym et al., 2012). However, it is not clear whether the skull tap and auditory tone burst elicit the same pattern of cortical activity. Both forms of stimulation target the otolith response, which provides a measurement of vestibular function independent from semicircular canals. This is of high importance for studying the vestibular disorders related to otolith deficits. Previous imaging studies have documented activity in the anterior and posterior insula, superior temporal gyrus, inferior parietal lobule, pre and post central gyri, inferior frontal gyrus, and the anterior cingulate cortex in response to different modes of vestibular stimulation (Bottini et al., 1994; Dieterich et al., 2003; Emri et al., 2003; Schlindwein et al., 2008; Janzen et al., 2008). Here we hypothesized that the skull tap elicits the similar pattern of cortical activity as the auditory tone burst. Subjects put on a set of MR compatible skull tappers and headphones inside the 3T GE scanner, while lying in supine position, with eyes closed. All subjects received both forms of the stimulation, however, the order of stimulation with auditory tone burst and air-conducted skull tap was counterbalanced across subjects. Pneumatically powered skull tappers were placed bilaterally on the cheekbones. The vibration of the cheekbone was transmitted to the vestibular cortex, resulting in vestibular response (Halmagyi et al., 1995). Auditory tone bursts were also delivered for comparison. To validate
Pintar, Frank A; Philippens, Mat M G M; Zhang, JiangYue; Yoganandan, Narayan
The objective of the study was to obtain helmet-to-head contact forces from experiments, use a human head finite element model to determine regional responses, and compare outputs to skull fracture and brain injury thresholds. Tests were conducted using two types of helmets (A and B) fitted to a head-form. Seven load cells were used on the head-form back face to measure helmet-to-head contact forces. Projectiles were fired in frontal, left, right, and rear directions. Three tests were conducted with each helmet in each direction. Individual and summated force- and impulse-histories were obtained. Force-histories were inputted to the human head-helmet finite element model. Pulse durations were approximately 4 ms. One-third force and impulse were from the central load cell. 0.2% strain and 40 MPa stress limits were not exceeded for helmet-A. For helmet-B, strains exceeded in left, right, and rear; pressures exceeded in bilateral directions; volume of elements exceeding 0.2% strains correlated with the central load cell forces. For helmet-A, volumes exceeding brain pressure threshold were: 5-93%. All elements crossed the pressure limit for helmet-B. For both helmets, no brain elements exceeded peak principal strain limit. These findings advance our understanding of skull and brain biomechanics from helmet-head contact forces.
Ricci, Alessio; Marella, Gian Luca; Apostol, Mario Alexandru
The present study introduces a new approach to computer-assisted face/skull matching used for personal identification purposes in forensic anthropology. In this experiment, the authors formulated an algorithm able to identify the face of a person suspected to have disappeared, by comparing the respective person's facial image with the skull radiograph. A total of 14 subjects were selected for the study, from which a facial photograph and skull radiograph were taken and ultimately compiled into a database, saved to the hard drive of a computer. The photographs of the faces and corresponding skull radiographs were then drafted using common photographic software, taking caution not to alter the informational content of the images. Once computer generated, the facial images and menu were displayed on a color monitor. In the first phase, a few anatomic points of each photograph were selected and marked with a cross to facilitate and more accurately match the face with its corresponding skull. In the second phase, the above mentioned cross grid was superimposed on the radiographic image of the skull and brought to scale. In the third phase, the crosses were transferred to the cranial points of the radiograph. In the fourth phase, the algorithm calculated the distance of each transferred cross and the corresponding average. The smaller the mean value, the greater the index of similarity between the face and skull.A total of 196 cross-comparisons were conducted, with positive identification resulting in each case. Hence, the algorithm matched a facial photograph to the correct skull in 100% of the cases.
King, Randy; Rieke, Viola; Pauly, Kim Butts
MR-guided therapeutic ultrasound is becoming increasingly prominent among a range of brain treatments from localized tumors and pain alleviation to neurostimulation. To investigate the influence of the skull on the acoustic field, an appropriate animal model must be established and so the effect of the rat skull needs to be considered and possibly compensated for, when using it as a model to perform therapeutic ultrasound in the brain. Temperature monitoring of both in-vivo and ex vivo experiments was performed in a 3T MRI (GE Signa, Milwaukee WS) using the PRF method. Sonications were performed with a 2D PZT array comprised of 1024 elements at 0.55 MHz. Intensities were kept low enough to limit temperature rise in the brain to about 10° C. Temperature maps were acquired 2-3 mm from the inner surface of the skull in phantom material, which was placed behind the skull. Three ex-vivo skulls were used. A grid pattern covering the entire skull was laid out for sonications. Only 11/48 sonications created a small single spot showing temperature rise in phantom material. In all other sonications the heat was very diffuse with multiple focal spots. This is compared to the phantom with no skull were 2/41 sonications did not create a small single spots of temperature rise, and in those two spots edge effects can be contributed to the unfocused pattern. All other sonications, performed at the same depth of sonication as in the skull, created an individual thermal spot, which was on average within 0.5 mm in any direction from the expected location.
Since 1985, more than 2,000 titanium aluminide heats have been produced using the Induction Skull Melting (ISM) process. The history of ISM/Gamma production will be discussed in this paper. Gamma titanium aluminide processing with Induction Skull Melting offers many advantages over other types of reactive alloy melting methods. These advantages will be discussed as well as drawbacks. Also, potential markets and applications for ISM/Gamma will be presented.
Kirkman, Matthew A.; Borg, Anouk; Al-Mousa, Alaa; Haliasos, Nikolaos; Choi, David
Background Improved treatment and survival of patients with skull base tumors has made the assessment of quality-of-life (QoL) in this population increasingly important. This article provides a comprehensive systematic review pertaining to QoL assessment in adults undergoing anterior skull base surgery. Methods We performed a literature search using the electronic databases of Ovid Medline and Embase. Additional articles were identified through a search using the phrase anterior skull base. Further articles were sought through hand-searching relevant journals and reference lists of identified articles. Results Our search strategy identified 29 articles for inclusion in our systematic review, with considerable variation between studies in population characteristics, methodological design and quality, follow-up length, and outcome assessment. The most commonly used QoL tools were the Karnofsky Performance Status and the Anterior Skull Base Questionnaire. QoL following anterior skull base surgery appears to improve beyond preoperative levels in the months after surgery. For patients undergoing endoscopic skull base surgery, the gain in QoL appears to be greater and may manifest earlier, with no clear long-term deleterious effect on sinonasal outcomes compared with open surgery. Conclusions QoL after anterior skull base surgery in adults appears to improve within several months of surgery, but earlier and to a larger extent if the endoscopic approach is used. Given the relative paucity and heterogeneity of anterior skull base tumors, large-scale prospective multicentre studies utilizing valid and reliable multidimensional QoL tools are required. This may result in improved patient care, by understanding patients' needs better and facilitating the provision of reliable outcome data for clinical trials. PMID:24719794
Strangman, Gary E; Zhang, Quan; Li, Zhi
Near-infrared neuromonitoring (NIN) is based on near-infrared spectroscopy (NIRS) measurements performed through the intact scalp and skull. Despite the important effects of overlying tissue layers on the measurement of brain hemodynamics, the influence of scalp and skull on NIN sensitivity are not well characterized. Using 3555 Monte Carlo simulations, we estimated the sensitivity of individual continuous-wave NIRS measurements to brain activity over the entire adult human head by introducing a small absorption perturbation to brain gray matter and quantifying the influence of scalp and skull thickness on this sensitivity. After segmenting the Colin27 template into five tissue types (scalp, skull, cerebrospinal fluid, gray matter and white matter), the average scalp thickness was 6.9 ± 3.6 mm (range: 3.6-11.2mm), while the average skull thickness was 6.0 ± 1.9 mm (range: 2.5-10.5mm). Mean NIN sensitivity - defined as the partial path length through gray matter divided by the total photon path length - ranged from 0.06 (i.e., 6% of total path length) at a 20mm source-detector separation, to over 0.19 at 50mm separations. NIN sensitivity varied substantially around the head, with occipital pole exhibiting the highest NIRS sensitivity to gray matter, whereas inferior frontal regions had the lowest sensitivity. Increased scalp and skull thickness were strongly associated with decreased sensitivity to brain tissue. Scalp thickness always exhibited a slightly larger effect on sensitivity than skull thickness, but the effect of both varied with SD separation. We quantitatively characterize sensitivity around the head as well as the effects of scalp and skull, which can be used to interpret NIN brain activation studies as well as guide the design, development and optimization of NIRS devices and sensors.
Glenner, R A; Willey, P; Sledzik, P S; Junger, E P
This article discusses the dental techniques, methods and materials used in the South during the Civil War based on the dental restorations found in the skulls of four confederate soldiers. The skulls display a variety of dental filling materials, including thorium, lead, tin and tin amalgam. These materials were used at a time when more valuable materials, such as gold and silver, were not readily available in the South.
Tanner, Jaime B; Zelditch, Miriam L; Lundrigan, Barbara L; Holekamp, Kay E
Weaning represents a challenging transition for young mammals, one particularly difficult for species coping with extreme conditions during feeding. Spotted hyenas (Crocuta crocuta) experience such extreme conditions imposed by intense feeding competition during which the ability to consume large quantities of food quickly is highly advantageous. As adult spotted hyenas have massive skulls specialized for durophagy and can feed very rapidly, young individuals are likely at a competitive disadvantage until that specialized morphology is completely developed. Here we document developmental changes in skull size, shape, and mechanical advantage of the jaws. Sampling an ontogenetic series of Crocuta skulls from individuals ranging in age from 2 months to 18 years, we use linear measurements and geometric morphometrics to test hypotheses suggesting that size, limited mechanical advantage of the jaws, and/or limited attachment sites for jaw muscles might constrain the feeding performance of juveniles. We also examine skull development in relation to key life history events, including weaning and reproductive maturity, to inquire whether ontogeny of the feeding apparatus is slower or more protracted in this species than in carnivores not specialized for durophagy. We find that, although mechanical advantage reaches maturity in hyenas at 22 months, adult skull size is not achieved until 29 months of age, and skull shape does not reach maturity until 35 months. The latter is nearly 2 years after mean weaning age, and more than 1 year after reproductive maturity. Thus, skull development in Crocuta is indeed protracted relative to that in most other carnivores. Based on the skull features that continue to change and to provide additional muscle attachment area, protracted development may be largely due to development of the massive musculature required by durophagy. These findings may ultimately shed light on the adaptive significance of the unusual "role-reversed" pattern of
Thorp, Brian D; Sreenath, Satyan B; Ebert, Charles S; Zanation, Adam M
Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in reconstructive techniques. While smaller skull base defects with low intraoperative CSF flow have been successfully managed with a variety of avascular and/or noncellular techniques, larger defects with high CSF flow require more robust repairs often in the form of vascularized flaps, which confer excellent success rates in this setting. Despite these successful outcomes, a paucity of data describing specific patient and operative characteristics and their effects on repair exist. Therefore, a retrospective, consecutive chart review was performed on patients who underwent endoscopic skull base reconstruction with a vascularized flap in the setting of intraoperative CSF leaks. In this series, 151 patients with a mean age of 51 years underwent 152 vascularized flap skull base reconstructions for an array of benign and malignant pathologies. These vascularized flaps included 144 nasoseptal flaps, 6 endoscopic-assisted pericranial flaps, 1 facial artery buccinator flap, and 1 inferior turbinate flap that were used throughout all regions of the skull base. Perioperative (< 3 months) and postoperative (> 3 months) flap complications were assessed and revealed 3 perioperative flap defects (2.0%) defined as a visualized defect within the substrate of the flap and a total of 5 perioperative CSF leaks (3.3%). No patient experienced flap death/complete flap loss in the cohort. Assessed postoperative flap complications included 1 case (0.7%) of mucocele formation, 8 cases (5.3%) of prolonged skull base crusting, and 2 cases (1.3%) of donor-site complication, specifically septal perforation secondary to nasoseptal flap harvest. Among the 152 cases identified, 37 patients received radiation therapy while 114 patients did not undergo radiation therapy as part of the treatment profile. No significant association was found between perioperative complication rates and radiation therapy (p = 0
Astronomers have caught multiple massive galaxies in the act of merging about 4 billion years ago. This discovery, made possible by combining the power of the best ground- and space-based telescopes, uniquely supports the favoured theory of how galaxies form. ESO PR Photo 24/08 ESO PR Photo 24/08 Merging Galaxies in Groups How do galaxies form? The most widely accepted answer to this fundamental question is the model of 'hierarchical formation', a step-wise process in which small galaxies merge to build larger ones. One can think of the galaxies forming in a similar way to how streams merge to form rivers, and how these rivers, in turn, merge to form an even larger river. This theoretical model predicts that massive galaxies grow through many merging events in their lifetime. But when did their cosmological growth spurts finish? When did the most massive galaxies get most of their mass? To answer these questions, astronomers study massive galaxies in clusters, the cosmological equivalent of cities filled with galaxies. "Whether the brightest galaxies in clusters grew substantially in the last few billion years is intensely debated. Our observations show that in this time, these galaxies have increased their mass by 50%," says Kim-Vy Tran from the University of Zürich, Switzerland, who led the research. The astronomers made use of a large ensemble of telescopes and instruments, including ESO's Very Large Telescope (VLT) and the Hubble Space Telescope, to study in great detail galaxies located 4 billion light-years away. These galaxies lie in an extraordinary system made of four galaxy groups that will assemble into a cluster. In particular, the team took images with VIMOS and spectra with FORS2, both instruments on the VLT. From these and other observations, the astronomers could identify a total of 198 galaxies belonging to these four groups. The brightest galaxies in each group contain between 100 and 1000 billion of stars, a property that makes them comparable
van der Merwe, N J; Bezuidenhout, A J; Seegers, C D
In the present study the bones of the skull, excluding the hyoid apparatus, are described. All the bones are aerated by sinuses. In the occipital bone the squamous part is aerated from the sinus of the parietal bone, the lateral part is aerated from the tympanic bulla and the basal part from the sinus of the basisphenoid bone. Condylar foramens and hypoglossal canals are absent. A small interparietal bone is present at birth. At an early age it fuses with the surrounding cranial bones. The squamous part of the temporal bone lies sagittally in young animals, but moves progressively to a transverse plane as the animals age. A foramen lacerum is represented by jugular and oval foramens and the carotid canal. The body of the basisphenoid bone is excavated by the massive maxillary tuberosity. The latter extends to the oval foramen and contains the developing molar teeth. The ethmoturbinate, nasal and lacrimal bones are exceptionally small. In old bulls the palatine process of the incisive bones and their sinuses are gradually displaced by the palatine process of the maxillae.
Ogawa, Yoshinori; Imaizumi, Kazuhiko; Miyasaka, Sachio; Yoshino, Mineo
The purpose of this study is to generate a set of discriminant functions in order to estimate the sex of modern Japanese skulls. To conduct the analysis, the anthropological measurement data of 113 individuals (73 males and 40 females) were collected from recent forensic anthropological test records at the National Research Institute of Police Science, Japan. Birth years of the individuals ranged from 1926 to 1979, and age at death was over 19 years for all individuals. A total of 10 anthropological measurements were used in the discriminant function analysis: maximum cranial length, cranial base length, maximum cranial breadth, maximum frontal breadth, basion-bregmatic height, upper facial breadth, bizygomatic breadth, bicondylar breadth, bigonial breadth, and ramal height. As a result, nine discriminant functions were established. The classification accuracy ranged from 79.0 to 89.9% when the measurements of the 113 individuals were substituted into the established functions, from 77.8 to 88.1% when a leave-one-out cross-validation procedure was applied to the data, and from 86.7 to 93.0% when the measurements of 50 new individuals (25 males and 25 females), unrelated to the establishment of the discriminant functions, were used.
Rodrigues, George Yartsev, Slav; Coad, Terry; Bauman, Glenn
Helical tomotherapy (HT) is a radiation planning/delivery platform that combines inversely planned IMRT with on-board megavoltage imaging. A unique HT radiotherapy whole skull brain sparing technique is described in a patient with metastatic prostate cancer. An inverse HT plan and an accompanying back-up conventional lateral 6-MV parallel opposed pair (POP) plan with corresponding isodose distributions and dose-volume histograms (DVH) were created and assessed prior to initiation of therapy. Plans conforming to the planning treatment volume (PTV) with significant sparing of brain, optic nerve, and eye were created. Dose heterogeneity to the PTV target was slightly higher in the HT plan compared to the back-up POP plan. Conformal sparing of brain, optic nerve, and eye was achieved by the HT plan. Similar lens and brain stem/spinal cord doses were seen with both plans. Prospective clinical evaluation with relevant end points (quality of life, symptom relief) are required to confirm the potential benefits of highly conformal therapies applied to palliative situations such as this case.
Schmitz, L.; Wainwright, P. C.
Zooplanktivory is one of the most distinct trophic niches in coral reef fishes, and a number of skull traits are widely recognized as being adaptations for feeding in midwater on small planktonic prey. Previous studies have concluded that zooplanktivores have larger eyes for sharper visual acuity, reduced mouth structures to match small prey sizes, and longer gill rakers to help retain captured prey. We tested these three traditional hypotheses plus two novel adaptive hypotheses in labrids, a clade of very diverse coral reef fishes that show multiple independent evolutionary origins of zooplanktivory. Using phylogenetic comparative methods with a data set from 21 species, we failed to find larger eyes in three independent transitions to zooplanktivory. Instead, an impression of large eyes may be caused by a size reduction of the anterior facial region. However, two zooplanktivores ( Clepticus parrae and Halichoeres pictus) possess several features interpreted as adaptations to zooplankton feeding, namely large lens diameters relative to eye axial length, round pupil shape, and long gill rakers. The third zooplanktivore in our analysis, Cirrhilabrus solorensis, lacks all above features. It remains unclear whether Cirrhilabrus shows optical specializations for capturing planktonic prey. Our results support the prediction that increased visual acuity is adaptive for zooplanktivory, but in labrids increases in eye size are apparently not part of the evolutionary response.
Simons, E L; Rasmussen, D T
Fossil crania from quarry L-41, Fayum, Egypt, representing Catopithecus browni, a primate similar in size to callitrichids but with a catarrhine dental formula, provide the geologically earliest record of an anthropoidean skull. Catopithecus had postorbital closure developed to the stage seen in extant anthropoideans, with direct contact between zygomatic plate and maxillary tuber, isolating an anterior orbital fissure from the inferior orbital fissure. The auditory region also resembles that of later anthropoideans: The posterior carotid foramen is placed adjacent to the jugular fossa; a large promontory canal crosses the promontorium; and the annular ectotympanic is fused ventrally to the bulla. The incisors and canines show an assemblage of features found only among modern anthropoideans and adapoids. The face is characterized by a relatively deep maxilla, broad ascending wing of the premaxilla, and long nasal bones, yielding a moderate muzzle similar to that of Aegyptopithecus. The small braincase bears an anteriorly broad frontal trigon and a posteriorly developed sagittal crest. The mandibular symphysis is unfused even in mature adults. The encephalization quotient (EQ) probably falls within the range of Eocene prosimians, much lower than the EQs of Neogene anthropoideans.
Aquini, Mauro Guidotti; Marrone, Antonio Carlos Huf; Schneider, Felipe Luis
The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14 mm. The IIS was identified in 31 cases (96.9%), assuming three different forms: plexuslike, venous lake, and mixed. The BP was found in 100% of the material analyzed; in 23 cases (71.9%) it proved to be the widest intercavernous communication. In 12 cases of this series the hypophysis was completely enveloped by venous structures, except at the level of the sellar diaphragm. ImagesFigure 1Figure 2Figure 3 PMID:17171164
Jayaprakash, Paul T; Srinivasan, G J
Forensic identification of juvenile skulls is a problem area. Although the skull suture patterns have been suggested for use in individualizing human remains by comparing antemortem and postmortem radiographs, the age at which such patterns stabilize and can be useful for identification had been indicated as 7 years. Subsequent researchers have also concurred that antemortem and postmortem radiographs taken after the 7th year would be sufficient to meet the Daubert standard criteria for identifying skulls using radiographs. The suggestions regarding the lower age limit for stabilization of suture patterns have not been verified so far. In this research, the patterns of the sutures in the ectocranial and endocranial surfaces of the lambdoid region in 22 juvenile skulls (age range 1-10 years) and 100 adult skulls (age range 17-70 years) were studied for the relative incidence of different types of suture patterns. The radiographic recordings of the suture patterns in the juvenile skulls were also compared with the patterns seen in the ectocranial and endocranial surfaces. The findings of this study support the proposition that the suture patterns are plastic during the juvenile stage and that they undergo significant remodeling during growth into adulthood. Indicating the possibility of growth related alterations in the sutural morphology, the onset of adulthood is suggested as the age for stabilization of suture patterns in the context of prescribing standards for such criteria as those relating to Daubert.
Torikoshi-Hatano, Aiko; Namera, Akira; Shiraishi, Hiroaki; Arima, Yousuke; Toubou, Hirokazu; Ezaki, Jiro; Morikawa, Masami; Nagao, Masataka
In forensic medicine, the personal identification of cadavers is one of the most important tasks. One method of estimating age at death relies on the high correlation between racemization rates in teeth and actual age, and this method has been applied successfully in forensic odontology for several years. In this study, we attempt to facilitate the analysis of racemized amino acids and examine the determination of age at death on the basis of the extent of aspartic acid (Asp) racemization in skull bones. The specimens were obtained from 61 human skull bones (19 females and 42 males) that underwent judicial autopsy from October 2010 to May 2012. The amount of D-Asp and L-Asp, total protein, osteocalcin, and collagen I in the skull bones was measured. Logistic regression analysis was performed for age, sex, and each measured protein. The amount of D-Asp in the female skull bones was significantly different from that in the male skull bones (p = 0.021), whereas the amount of L-Asp was similar. Thus, our study indicates that the amount of D-Asp in skull bones is different between the sexes.
Villa, C; Persson, L; Alexandersen, V; Lynnerup, N
A human skull with mandible from the Ngada District on the island of Flores, Indonesia, is described in order to contribute to the knowledge of variation in cranial architecture, which is important in interpretations of evolutionary cerebralisation. The skull was excavated in 1924 and sent to the National Museum in Copenhagen. The "Copenhagen Flores" (CF) male skull is radiocarbon-dated and of modern age. The cranium is small, but larger than e.g. Liang Bua skull (LB1) in every measurement. The (CT-scan based) cranial capacity of 1258 ml is normal for modern humans, but somewhat lower than values from the middle or upper Palaeolithics. The metric cranial data analysed in FORDISC, characterize the skull as a male Vietnamese rather than a Chinese or White individual. Tooth morphology shows the sundadont pattern and tooth size corresponds to that of teeth from Bali, Java and Malayan Orang Asli. Remarkable are the marked asymmetries in the dentition with rotation of an upper premolar and congenital absence of a third molar. In these respects the CF skull is similar to dentitions belonging to the pygmoid villagers of Rampasasa, a village not far from the Liang Bua cave, and to LB1.
Santana, Sharlene E; Grosse, Ian R; Dumont, Elizabeth R
The morphology and biomechanics of the vertebrate skull reflect the physical properties of diet and behaviors used in food acquisition and processing. We use phyllostomid bats, the most diverse mammalian dietary radiation, to investigate if and how changes in dietary hardness and loading behaviors during feeding shaped the evolution of skull morphology and biomechanics. When selective regimes of food hardness are modeled, we found that species consuming harder foods have evolved skull shapes that allow for more efficient bite force production. These species have shorter skulls and a greater reliance on the temporalis muscle, both of which contribute to a higher mechanical advantage at an intermediate gape angle. The evolution of cranial morphology and biomechanics also appears to be related to loading behaviors. Evolutionary changes in skull shape and the relative role of the temporalis and masseter in generating bite force are correlated with changes in the use of torsional and bending loading behaviors. Functional equivalence appears to have evolved independently among three lineages of species that feed on liquids and are not obviously morphologically similar. These trends in cranial morphology and biomechanics provide insights into behavioral and ecological factors shaping the skull of a trophically diverse clade of mammals.
TAMURA, TAKAMITSU; SATO, TAKU; KISHIDA, YUGO; ICHIKAWA, MASAHIRO; ODA, KEIKO; ITO, EIJI; WATANABE, TADASHI; SAKUMA, JUN; SAITO, KIYOSHI
ABSTRACT Background and Objective: Skull base chordomas are clinically malignant because of the difficulty of total removal, high recurrence rate, and occasional drop metastasis. Although aggressive surgical resection and postoperative radiation have been recommended, the long-term outcome remains unsatisfactory. Methods: From 1992 to 2011, we treated 24 patients with skull base chordoma using aggressive surgical removal as a principal strategy. Skull base approaches were selected according to tumor extension to remove the tumor and surrounding bone as completely as possible. After surgery, all patients were closely observed with MRI to find small and localized recurrent tumors, which were treated with gamma-knife radiosurgery or surgical resection. The mean postoperative follow-up duration was 10.2 years (range, 1-17.2 years). Results: The 5-, 10-, and 15-year overall survival rates were 86%, 72%, and 72%, respectively. The 5- and 10-year progression-free survival rates were 47% and 35%, respectively. Tumor extension to the brainstem and partial tumor removal were the factors related to poor survival. Conclusions: Our results suggest that aggressive surgical removal improves the long-term outcome of patients with skull base chordoma. We would like to emphasize that skull base chordomas should be aggressively removed using various skull base approaches. PMID:26370681
Luo, Li; Wang, Mengyang; Tian, Yun; Duan, Fuqing; Wu, Zhongke; Zhou, Mingquan; Rozenholc, Yves
Sex determination from skeletons is an important research subject in forensic medicine. Previous skeletal sex assessments are through subjective visual analysis by anthropologists or metric analysis of sexually dimorphic features. In this work, we present an automatic sex determination method for 3D digital skulls, in which a statistical shape model for skulls is constructed, which projects the high-dimensional skull data into a low-dimensional shape space, and Fisher discriminant analysis is used to classify skulls in the shape space. This method combines the advantages of metrical and morphological methods. It is easy to use without professional qualification and tedious manual measurement. With a group of Chinese skulls including 127 males and 81 females, we choose 92 males and 58 females to establish the discriminant model and validate the model with the other skulls. The correct rate is 95.7% and 91.4% for females and males, respectively. Leave-one-out test also shows that the method has a high accuracy.
Taniguchi, Masaaki; Kato, Amami; Taki, Takuyu; Tsuzuki, Takashi; Yoshimine, Toshiki; Kohmura, Eiji
The objective of the present study is to elucidate the feasibility of surgical maneuvers under the side-viewing endoscope during skull base tumor removal. The study focused on 51 patients who underwent tumor removal with the assistance of a side-viewing endoscope. The side-viewing endoscope enabled visualization and removal of residual tumors obscured by the skull base bone, cranial nerves, and other vital structures after a microscopic procedure. If the surgical field is surrounded by the dura or skull base tissue, not only curettage of a tumor but also semisharp dissection and bipolar coagulation are shown to be feasible. In the subarachnoid space, however, the primary feasible surgical maneuver was suctioning of the tumor. The extent of skull base resection could be reduced in 25 cases and additional tumor removal became possible in 47 cases. Application of the side-viewing endoscope enabled removal of the tumor compartment, the exposure of which has conventionally required an extensive skull base resection. This technique is a promising option for the treatment of skull base tumors.
Nakamura, Gen; Kato, Hidehiro
We investigated growth-related and sex-related morphological changes in the skulls of 144 North Pacific common minke whales Balaenoptera acutorostrata. Measurement was conducted at 39 points on the skull and mandible to extract individual allometric equations relating the length and zygomatic width of the skull. The results revealed no significant differences in skull morphology by sex except for width of occipital bone. The size relative to the skull of the anatomical parts involved in feeding, such as the rostrum and mandible, increased after birth. In contrast, the sensory organs and the anatomical regions involved in neurological function, such as the orbit, tympanic bullae, and foramen magnum, were fully developed at birth, and their relative size reduced over the course of development. This is the first study to investigate developmental changes in the skull morphology using more than 100 baleen whale specimens, and we believe the results of this study will contribute greatly to multiple areas of baleen whale research, including taxonomy and paleontology.
Dias, Paulo; Neves, Luis; Santos, Daniel; Coelho, Catarina; Ferreira, Maria Teresa; Santos, Helder; Silva, Samuel; Santos, Beatriz Sousa
Craniometric analysis plays an important role in anthropology studies and forensics. This paper presents CraMs, an application using a new craniometric approach based on 3D models of the skull. The main objective is to obtain, through a process supervised by anthropologists, the main points of interest used to compute craniometric measurements. The application aids this process by analyzing the skull geometry and automatically providing points of interest. The application also allows for semiautomatic point detection, where the user provides an initial guess that might be refined based on the curvature of the skull, as well as the manual selection of any other points of interest. Moreover, results comparing measurements obtained with CraMs and traditional craniometry methods on eight skulls suggest that the application provides comparable craniometric measurements and lower inter-observer variability. This approach offers advantages such as an easier access to skulls with no risk of bone damage and the possibility of defining new measurements based on morphology or other skull characteristics, which are not possible using traditional methods.
Li, Zhigang; Park, Byoung-Keon; Liu, Weiguo; Zhang, Jinhuan; Reed, Matthew P; Rupp, Jonathan D; Hoff, Carrie N; Hu, Jingwen
Head injury is the leading cause of fatality and long-term disability for children. Pediatric heads change rapidly in both size and shape during growth, especially for children under 3 years old (YO). To accurately assess the head injury risks for children, it is necessary to understand the geometry of the pediatric head and how morphologic features influence injury causation within the 0-3 YO population. In this study, head CT scans from fifty-six 0-3 YO children were used to develop a statistical model of pediatric skull geometry. Geometric features important for injury prediction, including skull size and shape, skull thickness and suture width, along with their variations among the sample population, were quantified through a series of image and statistical analyses. The size and shape of the pediatric skull change significantly with age and head circumference. The skull thickness and suture width vary with age, head circumference and location, which will have important effects on skull stiffness and injury prediction. The statistical geometry model developed in this study can provide a geometrical basis for future development of child anthropomorphic test devices and pediatric head finite element models.
Estrada, Hector; Rebling, Johannes; Razansky, Daniel
Ultrasound waves propagating in water or soft biological tissue are strongly reflected when encountering the skull, which limits the use of ultrasound-based techniques in transcranial imaging and therapeutic applications. Current knowledge on the acoustic properties of the cranial bone is restricted to far-field observations, leaving its near-field unexplored. We report on the existence of skull-guided acoustic waves, which was herein confirmed by near-field measurements of optoacoustically-induced responses in ex-vivo murine skulls immersed in water. Dispersion of the guided waves was found to reasonably agree with the prediction of a multilayered flat plate model. We observed a skull-guided wave propagation over a lateral distance of at least 3 mm, with a half-decay length in the direction perpendicular to the skull ranging from 35 to 300 μm at 6 and 0.5 MHz, respectively. Propagation losses are mostly attributed to the heterogenous acoustic properties of the skull.. It is generally anticipated that our findings may facilitate and broaden the application of ultrasound-mediated techniques in brain diagnostics and therapy.
Suzuki, Satoshi; Abe, Mikiko; Motokawa, Masaharu
We conducted an interspecific comparison of skulls from two closely related but differently sized mustelid species, Mustela itatsi and M. sibirica (Mammalia, Carnivora, Mustelidae); a sexual comparison within the latter species showed remarkable size dimorphism. We clarified several differences in skull proportion related to size using allometric analyses and qualitative comparisons. Allometric analysis revealed that the skulls of male M. itatsi (the smaller species) have a relatively long palate; a slender viscerocranium and postorbital constriction; a broad, short, and low neurocranium; small carnassials; and a short mandible with a thin body and small ramus compared to the skulls of male M. sibirica (the larger species). Similar results were obtained when male M. itatsi were compared to female M. sibirica, although the male M. itatsi had a broader viscerocranium than female M. sibirica. A sexual comparison in M. sibirica revealed a larger skull size among the males with a relatively wide viscerocranium; wide postorbital constriction; a slender, long, and high neurocranium; short and wide auditory bullae; short carnassials; and a long and high mandible compared to females. Qualitative comparisons revealed changes in a few characters depending on skull size or with respect to some cranial components in each species. The interspecific differences observed were clearly larger than the intraspecific differences for three qualitative characters. The allometric and qualitative differences detected between these species suggest that each species is not simply the dwarf and/or giant morph of the other, and complicated differences were clarified.
Kosugi, Kenzo; Takahashi, Satoshi; Sasaki, Hikaru; Tamura, Ryota; Ohara, Kentaro; Yoshida, Kazunari
Background: Intra or peritumoral hemorrhage of brain and skull tumors sometimes presents as stroke. Skull metastasis of chondrosarcoma is relatively rare, and furthermore, a case of intratumoural hemorrhage of skull metastasis of chondrosarcoma has not been reported. Case Description: A 73-year-old man underwent right lower leg amputation in the past because of chondrosarcoma and was operated for a skull metastasis. He presented with a sudden headache, and head computed tomography revealed a right acute subdural hematoma (SDH) adjacent to the recurrent skull metastatic tumor. The removal of the SDH and tumor resection were performed emergently. The intraoperative findings included metastatic invasion beyond the dura mater to as deep as the subdural space, and the histological diagnosis was metastatic chondrosarcoma. His postoperative course was uneventful. Conclusion: In the event of subdural invasion of a metastatic lesion, intratumoral hemorrhage may induce acute SDH, as in the present case. Similar to our case, most previous reports of intracranial chondrosarcoma hemorrhage have had an unclear etiology. Despite the rarity of this event, a patient with a history of malignancy presenting with nontraumatic acute SDH should be examined for the intratumoral hemorrhage of skull metastasis in the differential diagnosis. PMID:28303203
New observations from ESO's Very Large Telescope have, for the first time, provided direct evidence that young galaxies can grow by sucking in the cool gas around them and using it as fuel for the formation of many new stars. In the first few billion years after the Big Bang the mass of a typical galaxy increased dramatically and understanding why this happened is one of the hottest problems in modern astrophysics. The results appear in the 14 October issue of the journal Nature. The first galaxies formed well before the Universe was one billion years old and were much smaller than the giant systems - including the Milky Way - that we see today. So somehow the average galaxy size has increased as the Universe has evolved. Galaxies often collide and then merge to form larger systems and this process is certainly an important growth mechanism. However, an additional, gentler way has been proposed. A European team of astronomers has used ESO's Very Large Telescope to test this very different idea - that young galaxies can also grow by sucking in cool streams of the hydrogen and helium gas that filled the early Universe and forming new stars from this primitive material. Just as a commercial company can expand either by merging with other companies, or by hiring more staff, young galaxies could perhaps also grow in two different ways - by merging with other galaxies or by accreting material. The team leader, Giovanni Cresci (Osservatorio Astrofisico di Arcetri) says: "The new results from the VLT are the first direct evidence that the accretion of pristine gas really happened and was enough to fuel vigorous star formation and the growth of massive galaxies in the young Universe." The discovery will have a major impact on our understanding of the evolution of the Universe from the Big Bang to the present day. Theories of galaxy formation and evolution may have to be re-written. The group began by selecting three very distant galaxies to see if they could find evidence
Martínez, Rubén D F; Lamanna, Matthew C; Novas, Fernando E; Ridgely, Ryan C; Casal, Gabriel A; Martínez, Javier E; Vita, Javier R; Witmer, Lawrence M
is missing for at least 13 million years of the Cretaceous. The skull anatomy of Sarmientosaurus suggests that multiple titanosaurian species with dissimilar cranial structures coexisted in the early Late Cretaceous of southern South America. Furthermore, the new taxon possesses a number of distinctive morphologies-such as the ossified cervical tendon, extremely pneumatized cervical vertebrae, and a habitually downward-facing snout-that have rarely, if ever, been documented in other titanosaurs, thus broadening our understanding of the anatomical diversity of this remarkable sauropod clade. The latter two features were convergently acquired by at least one penecontemporaneous diplodocoid, and may represent mutual specializations for consuming low-growing vegetation.
Martínez, Rubén D. F.; Lamanna, Matthew C.; Novas, Fernando E.; Ridgely, Ryan C.; Casal, Gabriel A.; Martínez, Javier E.; Vita, Javier R.; Witmer, Lawrence M.
history of which is missing for at least 13 million years of the Cretaceous. The skull anatomy of Sarmientosaurus suggests that multiple titanosaurian species with dissimilar cranial structures coexisted in the early Late Cretaceous of southern South America. Furthermore, the new taxon possesses a number of distinctive morphologies—such as the ossified cervical tendon, extremely pneumatized cervical vertebrae, and a habitually downward-facing snout—that have rarely, if ever, been documented in other titanosaurs, thus broadening our understanding of the anatomical diversity of this remarkable sauropod clade. The latter two features were convergently acquired by at least one penecontemporaneous diplodocoid, and may represent mutual specializations for consuming low-growing vegetation. PMID:27115989
Rocks may be composed of layers and contain fracture sets that cause the hydraulic, mechanical and seismic properties of a rock to be anisotropic. Coexisting fractures and layers in rock give rise to competing mechanisms of anisotropy. For example: (1) at low fracture stiffness, apparent shear-wave anisotropy induced by matrix layering can be masked or enhanced by the presence of a fracture, depending on the fracture orientation with respect to layering, and (2) compressional-wave guided modes generated by parallel fractures can also mask the presence of matrix layerings for particular fracture orientations and fracture specific stiffness. This report focuses on two anisotropic sources that are widely encountered in rock engineering: fractures (mechanical discontinuity) and matrix layering (impedance discontinuity), by investigating: (1) matrix property characterization, i.e., to determine elastic constants in anisotropic solids, (2) interface wave behavior in single-fractured anisotropic media, (3) compressional wave guided modes in parallel-fractured anisotropic media (single fracture orientation) and (4) the elastic response of orthogonal fracture networks. Elastic constants of a medium are required to understand and quantify wave propagation in anisotropic media but are affected by fractures and matrix properties. Experimental observations and analytical analysis demonstrate that behaviors of both fracture interface waves and compressional-wave guided modes for fractures in anisotropic media, are affected by fracture specific stiffness (controlled by external stresses), signal frequency and relative orientation between layerings in the matrix and fractures. A fractured layered medium exhibits: (1) fracture-dominated anisotropy when the fractures are weakly coupled; (2) isotropic behavior when fractures delay waves that are usually fast in a layered medium; and (3) matrix-dominated anisotropy when the fractures are closed and no longer delay the signal. The
... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...
.org Forearm Fractures in Children The forearm is the part of the arm between the wrist and the elbow. It is ... two bones: the radius and the ulna. Forearm fractures are common in childhood, accounting for more than ...
.org Thighbone (Femur) Fractures In Children Page ( 1 ) The thighbone (femur) is the largest and strongest bone in the body. It can break ... Cause Statistics The most common cause of thighbone fractures in infants under 1 year old is child ...
A nasal fracture is a break in the bone over the ridge of the nose. It usually results from a blunt ... and is one of the most common facial fracture. Symptoms of a broken nose include pain, blood ...
... page: //medlineplus.gov/ency/presentations/100077.htm Bone fracture repair - series—Indications To use the sharing features ... Go to slide 4 out of 4 Overview Fractures of the bones are classified in a number ...
... that disrupts multiple diﬀerent joints and includes multiple fractures. Lisfranc injuries tend to damage the cartilage of ... include ligament strains and tears, as well as fractures and dislocations of bone (far right). (Le ) This ...
.org Growth Plate Fractures Page ( 1 ) The bones of children and adults share many of the same risks for injury. But because they ... to a unique injury called a growth plate fracture. Growth plates are areas of cartilage located near ...
... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...
Hadjisavvas, V.; Mylonas, N.; Ioannides, K.; Damianou, C.
BACKGROUND: In this paper an MR-compatible phantom for evaluating the propagation of high intensity focused ultrasound through the skull is presented. METHODS: The phantom was constructed using the thermoplastic material of ABS. The attenuation of ABS was measured using the transmission-reception method. Knowing the attenuation of human skull, the thickness of the phantom was chosen appropriately so as to achieve the same attenuation effect as in the case of human skull. The phantom was designed using CAD software and then manufactured in a rapid prototyping machine. In order to test the phantom a single element spherically focused transducer of 5 cm diameter, focusing at 10 cm and operating at either 0.5 MHz or 1 MHz was used. Brain tissue was mimicked either using gel phantoms or freshly excised tissue. RESULTS: The measured temperature due to an ultrasonic exposure with the presence of skull and without the skull was measured. It was found that the propagation of ultrasound through the skull was much better with the 0.5 MHz transducer. The skull phantom was tested also inside an MRI scanner, and we were able to detect temperature using the MRI technique of FSPGR indicating that with low frequency ultrasound propagation through the skull is possible. CONCLUSIONS: The skull phantom is a very successful tool for evaluating the propagation of ultrasound during the presence of skull.
Gordon, G M; Steyn, M
One of the aims of forensic science is to determine the identities of victims of crime. In some cases the investigators may have ideas as to the identities of the victims and in these situations, ante mortem photographs of the victims could be used in order to try and establish identity through skull-photo superimposition. The aim of this study was to evaluate the accuracy of a newly developed digital photographic superimposition technique on a South African sample of cadaver photographs and skulls. Forty facial photographs were selected and for each photo, 10 skulls (including the skull corresponding to the photo) were used for superimposition. The investigator did not know which of the 10 skulls corresponded to the photograph in question. The skulls were scanned 3-dimensionally, using a Cyberware™ Model 3030 Colour-3D Scanhead scanner. The photos were also scanned. Superimposition was done in 3D Studio Max and involved a morphological superimposition, whereby a skull is superimposed over the photo and assessed for a morphological match. Superimposition using selected anatomical landmarks was also performed to assess the match. A total of 400 skull-photo superimpositions were carried out using the morphological assessment and another 400 using the anatomical landmarks. In 85% of cases the correct skull was included in the possible matches for a particular photo using morphological assessment. However, in all of these cases, between zero and three other skulls out of 10 possibilities could also match a specific photo. In the landmark based assessment, the correct skull was included in 80% of cases. Once again, however, between one and seven other skulls out of 10 possibilities also matched the photo. This indicates that skull-photo superimposition has limited use in the identification of human skeletal remains, but may be useful as an initial screening tool. Corroborative techniques should also be used in the identification process.
Joseph, Jeffrey M; Glavas, Ioannis P
This review of orbital fractures has three goals: 1) to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2) to explain how to assess and examine a patient after periorbital trauma, and 3) to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training. PMID:21339801
Incidence of hip fracture increases exponentially with age. Women had two times higher hip fracture incidence than men. Major risk factors for the hip fracture are age, sex, bone mineral density, and previous fracture and others, but each risk factor contributes differently to development of the fracture by sites. Factors related to fall are important role in developing hip fracture.
Hindsø, K; Lauritzen, J B
We describe the connection between osteoporosis and Colles' fractures of the distal radius from an epidemiological and aetiological point of view. In addition, the value of these fractures as markers of osteoporosis and future risk of fracture is assessed. Several studies have clearly shown an epidemiological association between osteoporosis and fractures of the distal radius, with the association strongest for women up to 65 years of age and for osteoporosis located in the forearm. The association weakens for other locations and for older women. Osteoporosis may have some aetiologic significance for the development of Colles' fractures, but several extraskeletal factors are of equal or further importance. The occurrence of a Colles' fracture in the first 10-15 years after the postmenopause indicates an increased relative risk of sustaining another fracture in the future. However the relative risk approaches one after a few years and, because of the comparatively low absolute risk in this age-group, Colles' fracture as a risk factor contributes little to an assessment of the lifetime fracture risk. In a few longitudinal studies, Colles' fractures could not predict the long-term risk of osteoporosis. The presence of a Colles' fracture should lead to considerations concerning the skeletal and extraskeletal causes of the fracture for the purpose of initiating preventive and therapeutic measures.
Little, Kevin J
Elbow fractures are common in pediatric patients. Most injuries to the pediatric elbow are stable and require simple immobilization; however, more severe fractures can occur, often requiring operative stabilization and/or close monitoring. This article highlights the common fractures and dislocations about the pediatric elbow and discusses the history, evaluation, and treatment options for specific injuries.
Gapert, René; Rieder, Kurt
The discovery of human remains dating to the time of the Second World War is a common occurrence in Europe and the Pacific regions. This case report demonstrates the analysis of a bone fragment recovered from a Luftwaffe crash site in Austria during the summer of 2007. Eye-witness statements and official reports were used to reconstruct the historical background of the case. A recovered German military identity tag helped to identify the pilot. Aircraft parts, also discovered at the crash site in 2007, aided the identification of the aircraft type and corroborated the eye-witness reports of the final moments before and during the crash. The bone was analyzed chiefly to establish its human or non-human origin and to identify from which anatomic region the fragment could have arisen. It was identified as part of a human adult skull which exhibited peri-mortem fractures and heat damage as well as post-mortem vegetation staining. The historical background information in connection with the morphological analysis led to the presumptive identification of the cranial fragment as belonging to a downed German pilot.
Caumul, Radhekshmi; Polly, P David
The phenotype is a product of its phylogenetic history and its recent adaptation to local environments, but the relative importance of the two factors is controversial. We assessed the effects of diet, habitat, elevation, temperature, precipitation, body size, and mtDNA genetic divergence on shape variation in skulls, mandibles, and molars, structures that differ in their genetic and functional control. We asked whether these structures have adapted to environment to the same extent and whether they retain the same amount of phylogenetic signal. We studied these traits in intra- and interspecific populations of Eurasian marmots whose last common ancestor lived 2-5 million years ago. Path Analysis revealed that body size explained 10% of variation in skulls, 7% in mandibles, and 15% in molars. Local vegetation explained 7% of variation in skulls, 11% in mandibles, and 12% in molars. Dietary category explained 25% of variation in skulls, 11% in mandibles, and 9% in molars. Cyt b mtDNA divergence (phylogeny) explained 15% of variation in skulls, 7% in mandibles, and 5% in molars. Despite the percentages of phylogenetic variance, maximum-likelihood trees based on molar and skull shape recovered most phylogenetic groupings correctly, but mandible shape did not. The good performance of molars and skulls was probably due to different factors. Skulls are genetically and functionally more complicated than teeth, and they had more mathematically independent components of variation (5-6-in skulls compared to 3-in molars). The high proportion of diet-related variance was not enough to mask the phylogenetic signal. Molars had fewer independent components, but they also have less ecophenotypic variation and evolve more slowly, giving each component a proportionally stronger phylogenetic signal. Molars require larger samples for each operational taxonomic unit than the other structures because the proportion of within-taxon to between-taxon variation was higher. Good phylogenetic
Oliveira, Luiz Flamarion B.
The leopard cat, Prionailurus bengalensis (Kerr, 1792), is one of the most widespread Asian cats, occurring in continental eastern and southeastern Asia. Since 1929, several studies have focused on the morphology, ecology, and taxonomy of leopard cats. Nevertheless, hitherto there has been no agreement on basic aspects of leopard cat biology, such as the presence or absence of sexual dimorphism, morphological skull and body differences between the eleven recognized subspecies, and the biogeography of the different morphotypes. Twenty measurements on 25 adult leopard cat skulls from different Asian localities were analyzed through univariate and multivariate statistical approaches. Skull and external body measurements from studies over the last 77 years were assembled and organized in two categories: full data and summary data. Most of this database comprises small samples, which have never been statistically tested and compared with each other. Full data sets were tested with univariate and multivariate statistical analyses; summary data sets (i.e., means, SDs, and ranges) were analyzed through suitable univariate approaches. The independent analyses of the data from these works confirmed our original results and improved the overview of sexual dimorphism and geographical morphological variation among subspecies. Continental leopard cats have larger skulls and body dimensions. Skulls of Indochinese morphotypes have broader and higher features than those of continental morphotypes, while individuals from the Sunda Islands have skulls with comparatively narrow and low profiles. Cranial sexual dimorphism is present in different degrees among subspecies. Most display subtle sex-related variations in a few skull features. However, in some cases, sexual dimorphism in skull morphology is absent, such as in P. b. sumatranus and P. b. borneoensis. External body measurement comparisons also indicate the low degree of sexual dimorphism. Apart from the gonads, the longer hind
Price, Matthew C; Horn, Pamela L; Latshaw, James C
Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.
McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T
Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.
Chen, C. P.; Leipold, M. H.
The paper presents a study to determine the fracture toughness and to characterize fracture modes of silicon as a function of the orientation of single-crystal and polycrystalline material. It is shown that bar specimens cracked by Knoop microhardness indentation and tested to fracture under four-point bending at room temperature were used to determine the fracture toughness values. It is found that the lowest fracture toughness value of single crystal silicon was 0.82 MN/m to the 3/2 in the 111 plane type orientation, although the difference in values in the 111, 110, and 100 planes was small.
Subaşi, M; Kapukaya, A; Kesemenli, C; Coban, V
Rarely seen fractures are presented in this study. One case was a calcaneal spur, 2 cases osteochondroma pedicule fractures and talus posteromedial tubercle fracture due to direct trauma. Calcaneal spur and osteochondromas were removed surgically and posteromedial tubercle was treated by short-leg cast immobilization. In conclusion, we think that fractures of osteochondroma and calcaneal spur may be treated by surgical removal which do not cause any functional disorders after this operation, but fractures like the talus posteromedial tubercle should be treated conservatively by short-leg immobilization in the early period.
Nagasao, Tomohisa; Miyamoto, Junpei; Jiang, Hua; Tamaki, Tamotsu; Kaneko, Tsuyoshi
The etiology of blowout fractures is generally attributed to 2 mechanisms--increase in the pressure of the orbital contents (the hydraulic mechanism) and direct transmission of impacts on the orbital walls (the buckling mechanism). The present study aims to elucidate whether or not an interaction exists between these 2 mechanisms. We performed a simulation experiment using 10 Computer-Aided-Design skull models. We applied destructive energy to the orbits of the 10 models in 3 different ways. First, to simulate pure hydraulic mechanism, energy was applied solely on the internal walls of the orbit. Second, to simulate pure buckling mechanism, energy was applied solely on the inferior rim of the orbit. Third, to simulate the combined effect of the hydraulic and buckling mechanisms, energy was applied both on the internal wall of the orbit and inferior rim of the orbit. After applying the energy, we calculated the areas of the regions where fracture occurred in the models. Thereafter, we compared the areas among the 3 energy application patterns. When the hydraulic and buckling mechanisms work simultaneously, fracture occurs on wider areas of the orbital walls than when each of these mechanisms works separately. The hydraulic and buckling mechanisms interact, enhancing each other's effect. This information should be taken into consideration when we examine patients in whom blowout fracture is suspected.
Mazák, Ji H.; Christiansen, Per; Kitchener, Andrew C.
The tiger is one of the most iconic extant animals, and its origin and evolution have been intensely debated. Fossils attributable to extant pantherine species-lineages are less than 2 MYA and the earliest tiger fossils are from the Calabrian, Lower Pleistocene. Molecular studies predict a much younger age for the divergence of modern tiger subspecies at <100 KYA, although their cranial morphology is readily distinguishable, indicating that early Pleistocene tigers would likely have differed markedly anatomically from extant tigers. Such inferences are hampered by the fact that well-known fossil tiger material is middle to late Pleistocene in age. Here we describe a new species of pantherine cat from Longdan, Gansu Province, China, Panthera zdanskyi sp. nov. With an estimated age of 2.55–2.16 MYA it represents the oldest complete skull of a pantherine cat hitherto found. Although smaller, it appears morphologically to be surprisingly similar to modern tigers considering its age. Morphological, morphometric, and cladistic analyses are congruent in confirming its very close affinity to the tiger, and it may be regarded as the most primitive species of the tiger lineage, demonstrating the first unequivocal presence of a modern pantherine species-lineage in the basal stage of the Pleistocene (Gelasian; traditionally considered to be Late Pliocene). This find supports a north-central Chinese origin of the tiger lineage, and demonstrates that various parts of the cranium, mandible, and dentition evolved at different rates. An increase in size and a reduction in the relative size of parts of the dentition appear to have been prominent features of tiger evolution, whereas the distinctive cranial morphology of modern tigers was established very early in their evolutionary history. The evolutionary trend of increasing size in the tiger lineage is likely coupled to the evolution of its primary prey species. PMID:22016768
Mazák, Ji H; Christiansen, Per; Kitchener, Andrew C
The tiger is one of the most iconic extant animals, and its origin and evolution have been intensely debated. Fossils attributable to extant pantherine species-lineages are less than 2 MYA and the earliest tiger fossils are from the Calabrian, Lower Pleistocene. Molecular studies predict a much younger age for the divergence of modern tiger subspecies at <100 KYA, although their cranial morphology is readily distinguishable, indicating that early Pleistocene tigers would likely have differed markedly anatomically from extant tigers. Such inferences are hampered by the fact that well-known fossil tiger material is middle to late Pleistocene in age. Here we describe a new species of pantherine cat from Longdan, Gansu Province, China, Panthera zdanskyi sp. nov. With an estimated age of 2.55-2.16 MYA it represents the oldest complete skull of a pantherine cat hitherto found. Although smaller, it appears morphologically to be surprisingly similar to modern tigers considering its age. Morphological, morphometric, and cladistic analyses are congruent in confirming its very close affinity to the tiger, and it may be regarded as the most primitive species of the tiger lineage, demonstrating the first unequivocal presence of a modern pantherine species-lineage in the basal stage of the Pleistocene (Gelasian; traditionally considered to be Late Pliocene). This find supports a north-central Chinese origin of the tiger lineage, and demonstrates that various parts of the cranium, mandible, and dentition evolved at different rates. An increase in size and a reduction in the relative size of parts of the dentition appear to have been prominent features of tiger evolution, whereas the distinctive cranial morphology of modern tigers was established very early in their evolutionary history. The evolutionary trend of increasing size in the tiger lineage is likely coupled to the evolution of its primary prey species.
Lorenz, J.C. ); Hill, R.E. )
This study was undertaken in order to document and analyze the unique set of data on subsurface fracture characteristics, especially spacing, provided by the US Department of Energy's Slant Hole Completion Test well (SHCT-1) in the Piceance Basin, Colorado. Two hundred thirty-six (236) ft (71.9 m) of slant core and 115 ft (35.1 m) of horizontal core show irregular, but remarkably close, spacings for 72 natural fractures cored in sandstone reservoirs of the Mesaverde Group. Over 4200 ft (1280 m) of vertical core (containing 275 fractures) from the vertical Multiwell Experiment wells at the same location provide valuable information on fracture orientation, termination, and height, but only data from the SHCT-1 core allow calculations of relative fracture spacing. Within the 162-ft (49-m) thick zone of overlapping core from the vertical and deviated wellbores, only one fracture is present in vertical core whereas 52 fractures occur in the equivalent SHCT-1 core. The irregular distribution of regional-type fractures in these heterogeneous reservoirs suggests that measurements of average fracture spacing'' are of questionable value as direct input parameters into reservoir engineering models. Rather, deviated core provides data on the relative degree of fracturing, and confirms that cross fractures can be rare in the subsurface. 13 refs., 11 figs.
Abrahamsen, Sebastian Ørskov; Madsen, Christina Friis
The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have rarely been reported among elderly patients. Insufficiency fractures tend to occur in bones with decreased mechanical strength especially among elderly patients, in postmenopausal women and patients with underlying diseases. We describe a case of spontaneous sternum insufficiency fracture in a healthy man, with no known risk factors to fracture, or previous history of fractures. Sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other non-cardiac, non-pulmonary and non-traumatic causes of chest pain, especially among patients with known risk factors such as osteoporosis, chronic obstructive pulmonary disease, rheumatoid arthritis, systemic lupus erythematosus and patients on long-term steroid treatment. If diagnosed correctly, these patients can be discharged and treated as outpatients as this case emphasises. PMID:25326566
Hydraulic fractures represent a particular class of tensile fractures that propagate in solid media under pre-existing compressive stresses as a result of internal pressurization by an injected viscous fluid. The main application of engineered hydraulic fractures is the stimulation of oil and gas wells to increase production. Several physical processes affect the propagation of these fractures, including the flow of viscous fluid, creation of solid surfaces, and leak-off of fracturing fluid. The interplay and the competition between these processes lead to multiple length scales and timescales in the system, which reveal the shifting influence of the far-field stress, viscous dissipation, fracture energy, and leak-off as the fracture propagates.
Campomanes-Álvarez, B Rosario; Ibáñez, O; Navarro, F; Alemán, I; Botella, M; Damas, S; Cordón, O
Craniofacial superimposition can provide evidence to support that some human skeletal remains belong or not to a missing person. It involves the process of overlaying a skull with a number of ante mortem images of an individual and the analysis of their morphological correspondence. Within the craniofacial superimposition process, the skull-face overlay stage just focuses on achieving the best possible overlay of the skull and a single ante mortem image of the suspect. Although craniofacial superimposition has been in use for over a century, skull-face overlay is still applied by means of a trial-and-error approach without an automatic method. Practitioners finish the process once they consider that a good enough overlay has been attained. Hence, skull-face overlay is a very challenging, subjective, error prone, and time consuming part of the whole process. Though the numerical assessment of the method quality has not been achieved yet, computer vision and soft computing arise as powerful tools to automate it, dramatically reducing the time taken by the expert and obtaining an unbiased overlay result. In this manuscript, we justify and analyze the use of these techniques to properly model the skull-face overlay problem. We also present the automatic technical procedure we have developed using these computational methods and show the four overlays obtained in two craniofacial superimposition cases. This automatic procedure can be thus considered as a tool to aid forensic anthropologists to develop the skull-face overlay, automating and avoiding subjectivity of the most tedious task within craniofacial superimposition.
MacLeod, C D; Reidenberg, J S; Weller, M; Santos, M B; Herman, J; Goold, J; Pierce, G J
Skulls of odontocetes (toothed whales, including dolphins and porpoises) are typified by directional asymmetry, particularly in elements associated with the airway. Generally, it is assumed this asymmetry is related to biosonar production. However, skull asymmetry may actually be a by-product of selection pressure for an asymmetrically positioned larynx. The odontocete larynx traverses the pharynx and is held permanently in place by a ring of muscle. This allows prey swallowing while remaining underwater without risking water entering the lungs and causing injury or death. However, protrusion of the larynx through the pharynx causes a restriction around which prey must pass to reach the stomach. The larynx and associated hyoid apparatus has, therefore, been shifted to the left to provide a larger right piriform sinus (lateral pharyngeal food channel) for swallowing larger prey items. This asymmetry is reflected in the skull, particularly the dorsal openings of the nares. It is hypothesized that there is a relationship between prey size and skull asymmetry. This relationship was examined in 13 species of odontocete cetaceans from the northeast Atlantic, including four narrow-gaped genera (Mesoplodon, Ziphius, Hyperoodon, and Kogia) and eight wide-gaped genera (Phocoena, Delphinus, Stenella, Lagenorhynchus, Tursiops, Grampus, Globicephala, and Orcinus). Skulls were examined from 183 specimens to assess asymmetry of the anterior choanae. Stomach contents were examined from 294 specimens to assess prey size. Results show there is a significant positive relationship between maximum relative prey size consumed and average asymmetry relative to skull size in odontocete species (wide-gape species: R2 = 0.642, P = 0.006; narrow-gape species: R2 = 0.909, P = 0.031). This finding provides support for the hypothesis that the directional asymmetry found in odontocete skulls is related to an aquatic adaptation enabling swallowing large, whole prey while maintaining respiratory
Toro-Ibacache, Viviana; Zapata Muñoz, Víctor; O'Higgins, Paul
The human skull is gracile when compared to many Middle Pleistocene hominins. It has been argued that it is less able to generate and withstand high masticatory forces, and that the morphology of the lower portion of the modern human face correlates most strongly with dietary characteristics. This study uses geometric morphometrics and finite element analysis (FEA) to assess the relationship between skull morphology, muscle force and cranial deformations arising from biting, which is relevant in understanding how skull morphology relates to mastication. The three-dimensional skull anatomies of 20 individuals were reconstructed from medical computed tomograms. Maximal contractile muscle forces were estimated from muscular anatomical cross-sectional areas (CSAs). Fifty-nine landmarks were used to represent skull morphology. A partial least squares analysis was performed to assess the association between skull shape and muscle force, and FEA was used to compare the deformation (strains) generated during incisor and molar bites in two individuals representing extremes of morphological variation in the sample. The results showed that only the proportion of total muscle CSA accounted for by the temporalis appears associated with skull morphology, albeit weekly. However, individuals with a large temporalis tend to possess a relatively wider face, a narrower, more vertically oriented maxilla and a lower positioning of the coronoid process. The FEAs showed that, despite differences in morphology, biting results in similar modes of deformation for both crania, but with localised lower magnitudes of strains arising in the individual with the narrowest, most vertically oriented maxilla. Our results suggest that the morphology of the maxilla modulates the transmission of forces generated during mastication to the rest of the cranium by deforming less in individuals with the ability to generate proportionately larger temporalis muscle forces.
Na, Min Kyun; Kim, Jae Min; Cheong, Jin Whan; Ryu, Je Il; Kim, Hyun Woo
Esophageal carcinoma rarely metastasizes to the brain. Although some studies have mentioned esophageal cancer with solitary brain metastasis or with meningocerebral metastasis or with skull metastasis, multiple meningocerebral metastasis and extensive skull metastasis from squamous cell carcinoma of esophagus has not been reported in the literature. We encountered a case of an extensive osteolytic change of the skull and multiple meningocerebral metastases from esophageal carcinoma. PMID:27867927
Sengupta, Dhurjati P; Sengupta, Debapriya; Ghosh, Parthasarathi
Present work illustrates a scheme of quantitative description of the shape of the skull outlines of temnospondyl amphibians using bilaterally symmetric closed Fourier curves. Some special points have been identified on the Fourier fits of the skull outlines, which are the local maxima, or minima of the distances from the centroid of the points at the skull outline. These points denotes break in curvature of the outline and their positions can be compared to differentiate the skull shapes. The ratios of arc-lengths of the posterior and lateral outline of 58 temnospondyl skulls have been plotted to generate a triaguarity series of the skulls. This series grades different families, some of their genera and species as well as some individuals according to their posterior and lateral skull length ratios. This model while comparing different taxa, takes into account the entire arc-length of the outline of the temnospondyl skulls, and does not depend on few geometric or biological points used by earlier workers for comparing skull shapes.
Williams, D R; Watt, H C; Lees, A J
Background Falls and fractures contribute to morbidity and mortality in bradykinetic rigid syndromes. Methods The authors performed a retrospective case notes review at the Queen Square Brain Bank for Neurological Disorders and systematically explored the relation between clinical features and falls and fractures in 782 pathologically diagnosed cases (474 with Parkinson's disease (PD); 127 progressive supranuclear palsy (PSP); 91 multiple system atrophy (MSA); 46 dementia with Lewy bodies (DLB); 27 vascular parkinsonism; nine Alzheimer's disease; eight corticobasal degeneration). Results Falls were recorded in 606 (77.5%) and fractures in 134 (17.1%). In PD, female gender, symmetrical onset, postural instability, and autonomic instability all independently predicted time to first fall. In PD, PSP, and MSA latency to first fall was shortest in those with older age of onset of disease. Median latency from disease onset to first fall was shortest in Richardson's syndrome (12 months), MSA (42), and PSP‐parkinsonism (47), and longest in PD (108). In all patients fractures of the hip were more than twice as common as wrist and forearm fractures. Fractures of the skull, ribs, and vertebrae occurred more frequently in PSP than in other diseases. Conclusion Measures to prevent the morbidity associated with falls and fractures in bradykinetic rigid syndromes may be best directed at patients with the risk factors identified in this study. PMID:16543524
SHIN, Masahiro; KONDO, Kenji; SAITO, Nobuhito
Endoscopic endonasal approach (EEA) is expected to be ideal for the paramedian ventral skull base meningiomas, allowing wide access to the ventral skull base regions and realizing early devascularization of the tumor without retraction of the brain. We searched clinical reports of EEA for skull base meningiomas, written in English language, published before October 2014, using the PubMed literature search on the website. Skull base meningiomas are subdivided by the site of occurrence, olfactory groove (8 articles including 80 cases), tuberculum sellae (14 articles, 153 cases), cavernous sinus (2 articles, 8 cases), petroclival region (4 articles, 10 cases), and craniofacial region (2 articles, 5 cases), and the surgical outcomes of EEA were analyzed. In anterior skull base regions, EEA contributed to effective improvement of the symptoms in small and round-shaped meningiomas, but 25% of the patients had postoperative cerebrospinal fluid rhinorrhea. In cavernous sinus and petroclival regions, successful surgical removal largely depended on tumor consistency, and the extent of the surgical resection proportionally increased the risks of serious complications. Thus, judicious endoscopic resection with adjuvant radiotherapy or radiosurgery remains to be the most reasonable treatment option. To decrease the risks of surgical complications, the surgeons must master the closure techniques of dural defect and meticulous microsurgical procedure under endoscopic vision. Further progress will depend on the progresses of surgical technique in neurosurgeons engaging this potentially “minimally invasive” surgery. PMID:26345667
Spencer, M.E.; Leahy, R.M.; Mosher, J.C.
A versatile phantom for use in evaluating forward and inverse methods for MEG and EEG has been designed and is currently being constructed. The phantom consists of three major components: (i) a 32-element cur- rent dipole array, (ii) a PC-controlled dipole driver with 32 isolated channels allowing independent control of each dipole, (iii) spherical and human-skull mounts in which the dipole array is placed. Materials were selected throughout the phantom to produce minimal field distortions and artifacts to enable acquisition of high quality EEG and MEG data. The dipoles are made from a rigid narrow (0.84 mm) stainless steel coax cable. The dipole drivers can be configured as either current or voltage sources, are independently programmable and fully isolated, and are capable of producing arbitrary bipolar waveforms up to a 200 Hz bandwidth. The spherical mount is a single shell sphere filled with conductive gelatin. The human skull mount has three shells: ``brain`` (conducting gelatin), ``skull`` (the skull is impregnated with a low conductivity conducting gelatin), and ``scalp`` (a thin layer of rubber latex mixed with NaCl to achieve a conductivity matched to the brain). The conductivities will be adjusted to achieve approximately an 80:1:80 ratio. Data collected to date from the spherical phantom shows excellent agreement between measured surface potentials and that predicted from theory (27 of the 32 dipoles give better than 99.9% rms fit) and negligible leakage between dipoles. We are currently completing construction of the skull mount.
Carreira, L Miguel; Ferreira, A
We characterized the anatomical morphology of the transverse venous sinus (TVS) of 69 canine adult cadavers belonging to three groups: brachycephalic (B), dolichocephalic (D) and mesaticephalic (M). In addition, we outlined its path over the skull using five classic human craniometric points (CPs): the asterion (ast), the bregma (b), the glabella (g), the stephanion (st) and the pterion (pt). The study aimed to establish anatomical differences in the TVS between groups and in the relationship between the TVS and skull. We found that TVS anatomy and its relationships to skull landmarks vary markedly between the groups, with similar anatomical arrangements in B and M. The TVS length can be ranked as M < B < D (with D being the biggest), whereas the width can be ranked as M < D < B (with B being the widest) with the right side being smaller than the left. In the B and M groups, the TVS assumes a craniocaudal trajectory that is closer to the lateral skull wall than in D, where the TVS presents a caudocranial direction. By documenting the morphological characteristics of the TVS, we can create a set of anatomical references allowing construction of a basic framework to greatly decrease the probability of TVS injury during neuronavigation procedures when supported by a good knowledge of the skull, brain anatomies and their relationships.
Shapoori, Kiyanoosh; Sadler, Jeffrey; Ahmed, Zaki; Wydra, Adrian; Maeva, Elena; Malyarenko, Eugene; Maev, Roman
We report a new progress in the development of a portable ultrasonic transcranial imaging system, which is expected to significantly improve the clinical utility of transcranial diagnostic ultrasound. When conventional ultrasonic phased array and Doppler techniques are applied through thick skull bones, the ultrasound field is attenuated, deflected, and defocused, leading to image distortion. To address these deficiencies, the ultrasonic transcranial imaging system implements two alternative ultrasonic methods. The first method improves detection of small foreign objects, such as bone fragments, pieces of shrapnel, or bullets, lodged in the brain tissue. Using adaptive beamforming, the method compensates for phase aberration induced by the skull and refocuses the distorted ultrasonic field at the desired location. The second method visualizes the blood flow through intact human skull using ultrasonic speckle reflections from the blood cells, platelets, or contrast agents. By analyzing these random temporal changes, it is possible to obtain 2D or 3D blood flow images, despite the adverse influence of the skull. Both methods were implemented on an advanced open platform phased array controller driving linear and matrix array probes. They were tested on realistic skull bone and head phantoms with foreign inclusions and blood vessel models.
Schick, Bernhard; Dlugaiczyk, Julia
Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills. Following a summary about general aspects in pre-, intra-and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation and surgery of vestibular schwannomas and jugulotympanal paragangliomas. Based on these exemplary procedures, basic “dos and don’ts” of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed. An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process. PMID:24403973
Hernández-Jaimes, Carlos; Jerez, Adriana; Ramírez-Pinilla, Martha Patricia
The study of cranial design and development in Gymnophthalmidae is important to understand the ontogenetic processes behind the morphological diversity of the group and to examine the possible effects of microhabitat use and other ecological parameters, as well as phylogenetic constraints, on skull anatomy. Complete morphological descriptions of embryonic skull development within Gymnophthalmidae are non-existent. Likewise, very little is known about the complete chondrocranium of the family. Herein, the development of the skull of the semi-fossorial lizard Ptychoglossus bicolor is described along with an examination of the chondrocranium of other gymnophthalmid taxa and the teiid Cnemidophorus lemniscatus. Cranial chondrification begins with early condensations in the ethmoid, orbitotemporal and occipital regions of the chondrocranium as well as the viscerocranium. Ossification of the skull starts with elements of the dermatocranium (pterygoid, prefrontal, maxilla and jugal). The orbitosphenoid is the last chondral bone to appear. At birth, the skull is almost completely ossified and exhibits a large frontoparietal fontanelle. In general terms, the chondrocranium of the gymnophthalmids studied is characteristic of lacertiform terrestrial lizards, in spite of their life habits, and resembles the chondrocranium of C. lemniscatus in many aspects. However, the gymnophthalmids show great variation in the orbitosphenoid and a complex nasal capsule. The latter exhibits greater development of some nasal cartilages, which make it more complex than in C. lemniscatus. These characteristics might be related to microhabitat use and the well-developed olfactory and vomeronasal systems observed within this clade. PMID:22881276
Klaczko, Julia; Sherratt, Emma; Setz, Eleonore Z F
Snakes are a highly successful group of vertebrates, within great diversity in habitat, diet, and morphology. The unique adaptations for the snake skull for ingesting large prey in more primitive macrostomatan snakes have been well documented. However, subsequent diversification in snake cranial shape in relation to dietary specializations has rarely been studied (e.g. piscivory in natricine snakes). Here we examine a large clade of snakes with a broad spectrum of diet preferences to test if diet preferences are correlated to shape variation in snake skulls. Specifically, we studied the Xenodontinae snakes, a speciose clade of South American snakes, which show a broad range of diets including invertebrates, amphibians, snakes, lizards, and small mammals. We characterized the skull morphology of 19 species of xenodontine snakes using geometric morphometric techniques, and used phylogenetic comparative methods to test the association between diet and skull morphology. Using phylogenetic partial least squares analysis (PPLS) we show that skull morphology is highly associated with diet preferences in xenodontine snakes.
Breen, Joseph T.; Carlson, Matthew L.; Link, Michael J.; Moore, Eric J.; Neff, Brian A.; Driscoll, Colin L.W.
Objective Describe the clinical course and outcomes of patients with primary acinic cell carcinoma (ACC) of the parotid gland with skull base invasion or metastasis. Design Retrospective case series (1995–2011) at a single institution. Results Ten patients met study criteria. Mean and median time from initial diagnosis of parotid ACC to development of skull base disease were 14.6 and 10.2 years, respectively. Two patients demonstrated skull base disease on initial presentation. Those who pursued further treatment after developing disease at the skull base underwent surgery (4/7), stereotactic radiosurgery (4/7), or external beam radiation (3/7). The 10-year Kaplan-Meier estimated overall survival after initial diagnosis of parotid ACC was 80%. Once skull base invasion occurred, 2-year estimated overall survival was 50%. Conclusion Although primary ACC of the parotid generally caries an excellent prognosis, tumor control with cranial base disease is difficult and the majority of patients present with late aggressive recurrences. Our observations underscore the importance of long-term follow-up in this patient group. PMID:24294553
Meier, Josh C.; Remenschneider, Aaron K.; Sadow, Peter; Chambers, Kyle; Dedmon, Matt; Lin, Derrick T.; Holbrook, Eric H.; Metson, Ralph; Gray, Stacey T.
Background: Sphenoid sinus fungal balls (SSFB) are rare entities that can result in serious orbital and intracranial complications. There are few published reports of complications that result from SSFB. Objective: To review the incidence of skull base erosion and orbital or intracranial complications in patients who present with SSFB. Methods: A retrospective review was performed of all the patients with SSFB who were treated at the Massachusetts Eye and Ear Infirmary from 2006 to 2014. Presenting clinical data, radiology, operative reports, pathology, and postoperative course were reviewed. Results: Forty-three patients with SSFB were identified. Demographic data were compared between patients with (39.5%) and those without (61.5%) skull base erosion. Two patients underwent emergent surgery for acute complications of SSFB (one patient with blindness, one patient who had a seizure). Both patients with acute complications had evidence of skull base erosion, whereas no patients with an intact skull base developed an orbital or intracranial complication (p = 0.15). All the patients were surgically managed via an endoscopic approach. Conclusion: SSFBs are rare but may cause significant skull base erosion and potentially severe orbital and intracranial complications if not treated appropriately. Endoscopic sphenoidotomy is effective in treating SSFB and should be performed emergently in patients who presented with associated complications.
Füglein, Alexander; Riediger, Dieter
The LeFort I osteotomy is standard for corrective repositioning of the maxilla, but intraoperative, skull-related, three-dimensional repositioning of the maxilla remains unsolved. Different ways of improving the accuracy of intraoperative, preoperatively planned, skull-related, correcting movements have been described, including the measurement of vertical maxillary shift, use of positioning devices (such as a face bow or a halo frame), and computer-assisted navigation. Nevertheless, intraoperative three-dimensional control of maxillary shift is not standard. Intraoperatively adjusted positioning pins define an exactly reproducible skull-related position for a reference splint. Skull-related repositioning of the maxilla after osteotomy can be done precisely in combination with two further splints, each allowing for different, well-defined repositioning of the reference splint in relation to the maxillary dental arch. The positioning device can be inserted using the standard intraoral approaches of the Le Fort I osteotomy. It does not result in further radiation exposure for the patient besides that usually necessary for preoperative planning. Three-dimensional imaging and expensive, computer-assisted navigational systems are not required. In contrast to previous procedures, the new device allows for intraoperative, three-dimensional, skull-related repositioning of the maxilla exactly according to the position planned preoperatively.
Klaczko, Julia; Sherratt, Emma; Setz, Eleonore Z. F.
Snakes are a highly successful group of vertebrates, within great diversity in habitat, diet, and morphology. The unique adaptations for the snake skull for ingesting large prey in more primitive macrostomatan snakes have been well documented. However, subsequent diversification in snake cranial shape in relation to dietary specializations has rarely been studied (e.g. piscivory in natricine snakes). Here we examine a large clade of snakes with a broad spectrum of diet preferences to test if diet preferences are correlated to shape variation in snake skulls. Specifically, we studied the Xenodontinae snakes, a speciose clade of South American snakes, which show a broad range of diets including invertebrates, amphibians, snakes, lizards, and small mammals. We characterized the skull morphology of 19 species of xenodontine snakes using geometric morphometric techniques, and used phylogenetic comparative methods to test the association between diet and skull morphology. Using phylogenetic partial least squares analysis (PPLS) we show that skull morphology is highly associated with diet preferences in xenodontine snakes. PMID:26886549
Swaney, Philip J; Gilbert, Hunter B; Webster, Robert J; Russell, Paul T; Weaver, Kyle D
Objectives The purpose of this study is to experimentally evaluate the use of concentric tube continuum robots in endonasal skull base tumor removal. This new type of surgical robot offers many advantages over existing straight and rigid surgical tools including added dexterity, the ability to scale movements, and the ability to rotate the end effector while leaving the robot fixed in space. In this study, a concentric tube continuum robot was used to remove simulated pituitary tumors from a skull phantom. Design The robot was teleoperated by experienced skull base surgeons to remove a phantom pituitary tumor within a skull. Percentage resection was measured by weight. Resection duration was timed. Setting Academic research laboratory. Main Outcome Measures Percentage removal of tumor material and procedure duration. Results Average removal percentage of 79.8 ± 5.9% and average time to complete procedure of 12.5 ± 4.1 minutes (n = 20). Conclusions The robotic system presented here for use in endonasal skull base surgery shows promise in improving the dexterity, tool motion, and end effector capabilities currently available with straight and rigid tools while remaining an effective tool for resecting the tumor.
Berge, J K; Bergman, R A
The goal of this report is to define an average size and size range for many of the skull's foramina and to determine in which paired foramina asymmetry is commonly found so that researchers and clinicians examining foramina may have an anatomical reference. The incidence of foraminal variations is also discussed. Information on skull foraminal size and symmetry is increasingly important because of the advancements in radiologic techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). These methods are making difficult diagnoses of pathologic conditions of skull foramina possible. The foramina of 100 randomly selected dry skulls were measured and the symmetry of paired foramina was noted. The average, largest, and smallest sizes for 29 different foramina and the length of one canal are listed. Information regarding the symmetry of 27 paired foramina and the length symmetry of the infraorbital canal was also gathered. Specific data collected for paired foramina include the percent of skulls in which (1) neither foramen of the pair was present, (2) both foramina of a pair were present, (3) both foramina of the pair are present and were both the same size within 0.5 mm, and (4) both foramina of a pair are present but there was greater than 0.5 mm difference in size between them.
Li, Peng; Tang, Wei; Li, Jia; Tian, Dong W
This report introduced and evaluated our computer-assisted surgical method in the treatment of complex maxillofacial fractures. One patient with zygomatico-orbitomaxillary complex fracture underwent computed tomography to obtain DICOM data. Three-dimensional reconstruction and virtual surgical planning were carried out in the software MIMICS 10.01. Three reposition templates and 1 skull model were manufactured in our three-dimensional rapid prototyping machine. Reconstruction surgery was carried out according to the preoperative planning and with the guide of reposition templates. At 3-month follow-up, the treatment outcome was consistent with preoperative planning exactly, and the patient expressed high satisfaction with the surgery. Combination of reposition templates and rapid prototyping method demonstrated great practical value in complex maxillofacial fracture surgery.
Age- and gender-specific numbers of patients with hip fracture increase with age and peaked at the age 80-84; however, age- and gender-specific incidences increase exponentially with age. According to the recent nation-wide survey, the most common cause of hip fractures was a simple fall, 68.8% sustained fractures in-doors, and the incidences were higher in the winter than the summer period. More than 90% of patients with hip fracture were treated surgically and about 3/4 of patients with femoral neck fractures were treated with hemi-arthroplasty. Hip fractures for Asian people including Japanese are lower than those for Caucasians living in Northern Europe and North America; however, recent reports from the Asian area indicated an increase in the incidence with time.
Can, Cagdas; Gulactı, Umut; Sarıhan, Aydin; Topacoglu, Hakan
Tenderness over the sternum is a clue for possible sternal fracture. Sternal fractures usually occur at the body or manubrium. Lateral chest radiography could detect a sternum fracture, but the diagnosis is usually made by chest tomography. Traumatic sternum fracture considered as a marker of seriously life-threatening, high-energy injury. In hyperlipidemia, oxidized lipids accumulate in vascular tissues and trigger atherosclerosis. Such lipids also deposit in bone tissues where they may promote osteoporosis. In the literature, there is no previously reported traumatic sternal fracture due to hyperlipidemia-induced osteoporosis. Here, we report a case of a combined mixed type familial hyperlipidemia-induced osteoporosis in which the patient having seat belt on had an unexpected sternum fracture in a low-energy motor vehicle accident.
Sjöstedt, Sannia; Larsen, Christian Grønhøj; Bilde, Anders; von Buchwald, Christian
The risk of complications warrants treatment of most dislocated nasal fractures. Other injuries including other facial fractures and septal haematoma must be treated if present at the initial presentation. The usual treatment for a simple nasal fracture is closed reduction in local anaesthesia after five to seven days. Complicated cases require open reduction in general anaesthesia. Later revision of the deviated nose may become necessary in patients suffering from complications such as persistent nasal stenosis and/or deformity.
Pinheiro, Felipe L.; França, Marco A. G.; Lacerda, Marcel B.; Butler, Richard J.; Schultz, Cesar L.
Birds, dinosaurs, crocodilians, pterosaurs and their close relatives form the highly diverse clade Archosauriformes. Archosauriforms have a deep evolutionary history, originating in the late Permian, prior to the end-Permian mass extinction, and radiating in the Triassic to dominate Mesozoic ecosystems. However, the origins of this clade and its extraordinarily successful body plan remain obscure. Here, we describe an exceptionally preserved fossil skull from the Lower Triassic of Brazil, representing a new species, Teyujagua paradoxa, transitional in morphology between archosauriforms and more primitive reptiles. This skull reveals for the first time the mosaic assembly of key features of the archosauriform skull, including the antorbital and mandibular fenestrae, serrated teeth, and closed lower temporal bar. Phylogenetic analysis recovers Teyujagua as the sister taxon to Archosauriformes, and is congruent with a two-phase model of early archosauriform evolution, in response to two mass extinctions occurring at the end of the Guadalupian and the Permian.
Dusseldorp, Joseph Richard; Firmin, Françoise
Paul Tessier is widely regarded as the father of modern craniofacial surgery. Upon his passing in 2008, his private collection of human skulls was purchased by the French Association of Facial Surgeons to ensure the collection would remain in France. The first public exhibition of the skulls was held in the medical museum of the University of Paris Descartes in April 2014. From this collection of skulls and the imagination of Tessier an entirely new specialty was created. Modern craniofacial surgery, now is an integral part of any pediatric plastic surgery department. Cranial and facial osteotomies have also become commonplace in both traumatic and aesthetic surgery. The goals for craniofacial deformity are now a return to completely normal appearance and function, as Tessier always believed they should be.
Lober, Robert M.; Doan, Adam T.; Matsumoto, Craig I.; Kenning, Tyler J.; Evans, James J.
Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route. PMID:27293965
Hoff, Stephen R; Edwards, Michael S B; Bailey, C Martin; Koltai, Peter J
Basal skull base herniations, including meningoceles and encephaloceles, are rare and may present with characteristic facial and neurologic features. The traditional craniotomy approach has known morbidity, and nasal endoscopy may not allow for control of large posterior basal defects, especially in newborns. We present two cases of successful repair of basal transsphenoidal meningoceles using an oral-transpalatal approach. The first patient with an intact palate presented with respiratory distress, and a palatectomy was performed for access to the skull base. The second patient had a large basal herniation that was reduced through a congenital midline cleft palate, and a calvarial bone graft was used to repair the defect. A literature search revealed 10 previous successful cases using the transpalatal repair, which allows for excellent access, low morbidity, and a team-oriented method to skull base surgery.
Wang, Shuping; Shibahara, Nanae; Kuramashi, Daishi; Okawa, Shinpei; Kakuta, Naoto; Okada, Eiji; Maki, Atsushi; Yamada, Yukio
In order to investigate the effects of anatomical variation in human heads on the optical mapping of brain activity, we perform simulations of optical mapping by solving the photon diffusion equation for layered-models simulating human heads using the finite element method (FEM). Particularly, the effects of the spatial variations in the thicknesses of the skull and cerebrospinal fluid (CSF) layers on mapping images are investigated. Mapping images of single active regions in the gray matter layer are affected by the spatial variations in the skull and CSF layer thicknesses, although the effects are smaller than those of the positions of the active region relative to the data points. The increase in the skull thickness decreases the sensitivity of the images to active regions, while the increase in the CSF layer thickness increases the sensitivity in general. The images of multiple active regions are also influenced by their positions relative to the data points and by their depths from the skin surface.
Ibáñez, Oscar; Valsecchi, Andrea; Cavalli, Fabio; Huete, María Isabel; Campomanes-Alvarez, Blanca Rosario; Campomanes-Alvarez, Carmen; Vicente, Ricardo; Navega, David; Ross, Ann; Wilkinson, Caroline; Jankauskas, Rimantas; Imaizumi, Kazuhiko; Hardiman, Rita; Jayaprakash, Paul Thomas; Ruiz, Elena; Molinero, Francisco; Lestón, Patricio; Veselovskaya, Elizaveta; Abramov, Alexey; Steyn, Maryna; Cardoso, Joao; Humpire, Daniel; Lusnig, Luca; Gibelli, Daniele; Mazzarelli, Debora; Gaudio, Daniel; Collini, Federica; Damas, Sergio
Craniofacial superimposition has the potential to be used as an identification method when other traditional biological techniques are not applicable due to insufficient quality or absence of ante-mortem and post-mortem data. Despite having been used in many countries as a method of inclusion and exclusion for over a century it lacks standards. Thus, the purpose of this research is to provide forensic practitioners with standard criteria for analysing skull-face relationships. Thirty-seven experts from 16 different institutions participated in this study, which consisted of evaluating 65 criteria for assessing skull-face anatomical consistency on a sample of 24 different skull-face superimpositions. An unbiased statistical analysis established the most objective and discriminative criteria. Results did not show strong associations, however, important insights to address lack of standards were provided. In addition, a novel methodology for understanding and standardizing identification methods based on the observation of morphological patterns has been proposed.
Pinheiro, Felipe L; França, Marco A G; Lacerda, Marcel B; Butler, Richard J; Schultz, Cesar L
Birds, dinosaurs, crocodilians, pterosaurs and their close relatives form the highly diverse clade Archosauriformes. Archosauriforms have a deep evolutionary history, originating in the late Permian, prior to the end-Permian mass extinction, and radiating in the Triassic to dominate Mesozoic ecosystems. However, the origins of this clade and its extraordinarily successful body plan remain obscure. Here, we describe an exceptionally preserved fossil skull from the Lower Triassic of Brazil, representing a new species, Teyujagua paradoxa, transitional in morphology between archosauriforms and more primitive reptiles. This skull reveals for the first time the mosaic assembly of key features of the archosauriform skull, including the antorbital and mandibular fenestrae, serrated teeth, and closed lower temporal bar. Phylogenetic analysis recovers Teyujagua as the sister taxon to Archosauriformes, and is congruent with a two-phase model of early archosauriform evolution, in response to two mass extinctions occurring at the end of the Guadalupian and the Permian.
Endo, Hideki; Hikida, Tsutomu; Chou, Loke Ming; Fukuta, Katsuhiro; Stafford, Brian J
The skull adaptation was functional-morphologically examined in 14 species of the tree shrews. From the data of the proportion indices, the similarities were confirmed between T. minor and T. gracilis, T. tana and T. dorsalis, and T. longipes and T. glis. We demonstrated that the splanchnocranium was elongated in terrestrial T. tana and T. dorsalis and shortened in arboreal T. minor and T. gracilis from the proportion data. In both dendrogram from the matrix of the Q-mode correlation coefficients and scattergram from the canonical discriminant analysis, the morphological similarities in the skull shape suggested the terrestrial-insectivorous adaptation of T. tana and T. dorsalis, and the arboreal adaptation of T. minor and T. gracilis. Since the osteometrical skull similarities were indicated among the three species of Tupaia by cluster and canonical discriminant analyses, the arbo-terrestrial behavior and its functional-morphological adaptation may be commonly established in T. montana, T. longipes and T. glis.
Nicolai, Piero; Paderno, Alberto; Farina, Davide; Piazza, Cesare
Removal of parapharyngeal space (PPS) schwannomas approaching the skull base through a purely transcervical approach requires adequate visualization of the surgical field to obtain complete resection with minimal sequelae. This is a retrospective series of four patients undergoing transcervical removal of sympathetic chain PPS schwannomas abutting the skull base by an intracapsular microdebrider tumor cavitation. Radiologic data, complications, functional outcomes, and follow-up status were considered. MRI was suggestive of PPS schwannoma in all cases, and correctly predicted the nerve of origin in three out of four cases. All patients developed postoperative Claude Bernard-Horner and first-bite syndromes. One patient also presented temporary neuropraxia of the IX cranial nerve, and another of the IX and X cranial nerves. Microdebrider cavitation of sympathetic chain PPS schwannoma abutting the skull base proved to be a reliable technique allowing good visualization of adjacent neural and vascular structures through a purely transcervical approach, while maintaining a low complication rate.
Pinheiro, Felipe L.; França, Marco A. G.; Lacerda, Marcel B.; Butler, Richard J.; Schultz, Cesar L.
Birds, dinosaurs, crocodilians, pterosaurs and their close relatives form the highly diverse clade Archosauriformes. Archosauriforms have a deep evolutionary history, originating in the late Permian, prior to the end-Permian mass extinction, and radiating in the Triassic to dominate Mesozoic ecosystems. However, the origins of this clade and its extraordinarily successful body plan remain obscure. Here, we describe an exceptionally preserved fossil skull from the Lower Triassic of Brazil, representing a new species, Teyujagua paradoxa, transitional in morphology between archosauriforms and more primitive reptiles. This skull reveals for the first time the mosaic assembly of key features of the archosauriform skull, including the antorbital and mandibular fenestrae, serrated teeth, and closed lower temporal bar. Phylogenetic analysis recovers Teyujagua as the sister taxon to Archosauriformes, and is congruent with a two-phase model of early archosauriform evolution, in response to two mass extinctions occurring at the end of the Guadalupian and the Permian. PMID:26965521
Noohi, F.; Kinnaird, C.; Wood, S.; Bloomberg, J.; Mulavara, A.; Seidler, R.
The current study characterizes brain activation in response to two modes of vestibular stimulation: skull tap and auditory tone burst. The auditory tone burst has been used in previous studies to elicit either the vestibulo-spinal reflex (saccular-mediated colic Vestibular Evoked Myogenic Potentials (cVEMP)), or the ocular muscle response (utricle-mediated ocular VEMP (oVEMP)). Some researchers have reported that air-conducted skull tap elicits both saccular and utricle-mediated VEMPs, while being faster and less irritating for the subjects. However, it is not clear whether the skull tap and auditory tone burst elicit the same pattern of cortical activity. Both forms of stimulation target the otolith response, which provides a measurement of vestibular function independent from semicircular canals. This is of high importance for studying otolith-specific deficits, including gait and balance problems that astronauts experience upon returning to earth. Previous imaging studies have documented activity in the anterior and posterior insula, superior temporal gyrus, inferior parietal lobule, inferior frontal gyrus, and the anterior cingulate cortex in response to different modes of vestibular stimulation. Here we hypothesized that skull taps elicit similar patterns of cortical activity as the auditory tone bursts, and previous vestibular imaging studies. Subjects wore bilateral MR compatible skull tappers and headphones inside the 3T GE scanner, while lying in the supine position, with eyes closed. Subjects received both forms of the stimulation in a counterbalanced fashion. Pneumatically powered skull tappers were placed bilaterally on the cheekbones. The vibration of the cheekbone was transmitted to the vestibular system, resulting in the vestibular cortical response. Auditory tone bursts were also delivered for comparison. To validate our stimulation method, we measured the ocular VEMP outside of the scanner. This measurement showed that both skull tap and auditory
Curtis, Neil; Jones, M. E. H.; Evans, S. E.; O'Higgins, P.; Fagan, M. J.
The skull is composed of many bones that come together at sutures. These sutures are important sites of growth, and as growth ceases some become fused while others remain patent. Their mechanical behaviour and how they interact with changing form and loadings to ensure balanced craniofacial development is still poorly understood. Early suture fusion often leads to disfiguring syndromes, thus is it imperative that we understand the function of sutures more clearly. By applying advanced engineering modelling techniques, we reveal for the first time that patent sutures generate a more widely distributed, high level of strain throughout the reptile skull. Without patent sutures, large regions of the skull are only subjected to infrequent low-level strains that could weaken the bone and result in abnormal development. Sutures are therefore not only sites of bone growth, but could also be essential for the modulation of strains necessary for normal growth and development in reptiles. PMID:23804444
Ehmcke, Jens; Clemen, Günter
The skulls of six species of plethodontid salamanders of the genus Bolitoglossa from Costa Rica and Panama, Bolitoglossa colonnea, B. dofleini, B. lignicolor, B. marmorea, B. schizodactyla and B. striatula are comparatively analysed. All species are terrestrial or slightly arboreal and show no life-mode-dependent skull characteristics. Heads cleared by transparent preparation and stained in toto were used for examination of the skull structure and paraffin sections of the gonads were prepared to confirm sexual maturity of each individual. Focussing on the size of the premaxillary pars dentalis, the degree of fusion of the processus dorsales praemaxillares and the presence or absence of the paired prefrontals we state that B. dofleini and B. striatula possess more ancestral characteristics, B. marmorea is situated in an intermediate position and B. colonnea, B. lignicolor and B. schizodactyla show more advanced characteristics.
Gomes, Eymeric; Degueurce, Christophe; Ruel, Yannick; Dennis, Ruth; Begon, Dominique
Magnetic resonance (MR) images of the brain of four normal cats were reviewed retrospectively to assess the emergence and course of the cranial nerves (CNs). Two-millimeter-thick images were obtained in transverse, sagittal, and dorsal planes using a 1.5 T unit. CN skull foramina, as anatomic landmarks for MR imaging, were identified by computed tomography performed on an isolated cat skull using thin wire within each skull foramen. Thin slice (1 mm slice thickness) images were obtained with a high-resolution bone filter scan protocol. The origins of CNs II, V, VII, and VIII and the group of IX, X, XI, and XII could be identified. The pathway and proximal divisions of CNs V were described. CNs III, IV, and VI were not distinguished from each other but could be seen together in the orbital fissure. CN V was characterized by slight contrast enhancement.
Bink, A; Berkefeld, J; Zanella, F
Computed tomography (CT) and magnetic resonance imaging (MRI) are suitable methods for examination of the skull base. Whereas CT is used to evaluate mainly bone destruction e.g. for planning surgical therapy, MRI is used to show pathologies in the soft tissue and bone invasion. High resolution and thin slice thickness are indispensible for both modalities of skull base imaging. Detailed anatomical knowledge is necessary even for correct planning of the examination procedures. This knowledge is a requirement to be able to recognize and interpret pathologies. MRI is the method of choice for examining the cranial nerves. The total path of a cranial nerve can be visualized by choosing different sequences taking into account the tissue surrounding this cranial nerve. This article summarizes examination methods of the skull base in CT and MRI, gives a detailed description of the anatomy and illustrates it with image examples.
Endo, H; Cuisin, J; Nadee, N; Nabhitabhata, J; Suyanto, A; Kawamoto, Y; Nishida, T; Yamada, J
Geographical variation was examined morphologically in the common tree shrew (Tupaia glis) in some Indochinese and Malayan regions. Osteometrical examination and principal component analysis elucidated the morphological differences among various populations. The populations from southern and western Thailand were distinguished morphologically from the other populations. Variation in males from south Thailand and Kuala Lumpur suggests that the Isthmus of Kra may have an influence on the variation of skull morphology. However, the Isthmus of Kra was not completely considered as a factor of geographical separation in this species, because we could not confirm the separation in skull size and shape between the localities at least in females. While, the Kanchanaburi population in western Thailand was significantly smaller than the other population in skull size, and constituted the morphologically separable group in our study.
Malekpour, Mahdi; Cohen-Gadol, Aaron A
Objective The evolution of neurosurgical techniques during Harvey Cushing's practice was immense. The authors illustrate this evolution using archived historical records from Harvey Cushing. Setting Historical patient records retained by the Cushing Center at Yale University Department of Neurosurgery. Design The authors present the case of one of Cushing's patients with a cholesteatoma. Results Cushing's surgical treatment of a cholesteatoma extending into the skull base is an example of his meticulous documentation and accelerated surgical techniques. Conclusions This case demonstrates how neurosurgical techniques advanced in the management of complex skull base tumors via a staged approach through the middle and posterior fossae at a time long before the development of modern skull base surgery.