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Cancers Feb 2022Meningiomas are the most common tumor of the central nervous system and can result in skeletal manifestations, including hyperostosis of the adjacent cranial bone,... (Review)
Review
Meningiomas are the most common tumor of the central nervous system and can result in skeletal manifestations, including hyperostosis of the adjacent cranial bone, enostoses, depressions, and enhanced vascular impressions. However, their identification in the paleopathological literature has been rare and few cases have received broad acceptance of the diagnosis. A review of the literature identified some 43 cases in which individuals were argued to have suffered from meningiomas. Most were seen in older individuals but were more likely to affect males. Eleven individuals exhibited hyperostosis, the most easily recognized indicator, usually located on the parietal bone; the hyperostotic region averaged 8 cm in diameter and 3.0 cm in height. Seven displayed lytic lesions with areas much smaller in size than the hyperostosis, and many had vascular changes. The other cases had indicators that varied greatly in terms of location and expression and included both sclerotic lesions and hollow areas. Several authors also suggested other possible causes of the lesions. The findings reflect the non-pathognomonic nature of the effects of meningiomas. However, given their likely frequency and potentially severe effects in ancient people, it is argued that they should be taken into consideration more frequently when performing differential diagnoses.
PubMed: 35205806
DOI: 10.3390/cancers14041058 -
Radiographics : a Review Publication of... 2021Calvarial abnormalities are usually discovered incidentally on radiologic studies or less commonly manifest with symptoms. This narrative review describes the imaging... (Review)
Review
Calvarial abnormalities are usually discovered incidentally on radiologic studies or less commonly manifest with symptoms. This narrative review describes the imaging spectrum of the abnormal calvaria. The extent, multiplicity, and other imaging features of calvarial abnormalities can be combined with the clinical information to establish a final diagnosis or at least narrow the differential considerations. Prior trauma (congenital depression, leptomeningeal cysts, posttraumatic osteolysis), surgical intervention (flap osteonecrosis and burr holes), infection, and inflammatory processes (sarcoidosis) can result in focal bone loss, which may also be seen with idiopathic disorders without (bilateral parietal thinning and Gorham disease) or with (Parry-Romberg syndrome) atrophy of the overlying soft tissues. Anatomic variants (arachnoid granulations, venous lakes, parietal foramina) and certain congenital lesions (epidermoid and dermoid cysts, atretic encephalocele, sinus pericranii, and aplasia cutis congenita) manifest as solitary lytic lesions. Other congenital entities (lacunar skull and dysplasia) display a diffuse pattern of skull involvement. Several benign and malignant primary bone tumors involve the calvaria and manifest as lytic, sclerotic, mixed lytic and sclerotic, or thinning lesions, whereas multifocal disease is mainly due to hematologic or secondary malignancies. Metabolic disorders such as rickets, hyperparathyroidism, renal osteodystrophy, acromegaly, and Paget disease involve the calvaria in a more diffuse pattern. RSNA, 2021.
Topics: Bone Diseases, Metabolic; Diagnostic Imaging; Encephalocele; Humans; Osteolysis; Skull
PubMed: 34197249
DOI: 10.1148/rg.2021200198 -
Journal of Anatomy Feb 2022In adult humans, the orbits vary mostly in their orientation in relation to the frontal bone profile, while the orientation of the cranial base and face are associated...
In adult humans, the orbits vary mostly in their orientation in relation to the frontal bone profile, while the orientation of the cranial base and face are associated with the anteroposterior dimensions of the parietal bone. Here we investigate the effect of parietal bone length on the orientation of the orbits, addressing craniofacial integration and head orientation. We applied shape analysis to a sample of computed tomography scans from 30 adult modern humans, capturing the outlines of the parietal and frontal bones, the orbits, and the lateral and midline cranial base, to investigate shape variation, covariation, and modularity. Results show that the orientation of the orbits varies in accordance with the anterior cranial base, and in association with changes in parietal bone longitudinal extension. Flatter, elongated parietal bones are associated with downwardly oriented orbits and cranial bases. Modularity analysis points to a significant integration among the orbits, anterior cranial base, and the frontal profile. While the orbits are morphologically integrated with the adjacent structures in terms of shape, the association with parietal bone size depends on the spatial relationship between the two blocks. Complementary changes in orbit and parietal bone might play a role in accommodating craniofacial variability and may contribute to maintain the functional axis of the head. To better understand how skull morphology and head posture relate, future studies should account for the spatial relationship between the head and the neck.
Topics: Adult; Face; Frontal Bone; Head; Humans; Parietal Bone; Skull; Skull Base
PubMed: 34498271
DOI: 10.1111/joa.13543 -
Journal of the National Comprehensive... Sep 2023Malignant peritoneal mesothelioma (MPeM) is a rare malignancy and represents 5% to 30% of malignant mesothelioma cases. The primary curative therapy for MPeM is radical... (Review)
Review
Malignant peritoneal mesothelioma (MPeM) is a rare malignancy and represents 5% to 30% of malignant mesothelioma cases. The primary curative therapy for MPeM is radical cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), with the strongest predictor of long-term survival being complete cytoreduction. There is a paucity of high-quality evidence available to guide management in MPeM; however, NCCN Guidelines for the management of MPeM were updated this year. In well-selected patients, 5-year overall survival exceeds 65%, but achieving optimal results requires careful preoperative evaluation and expert surgical management. Preoperative patient selection includes histology review and staging with cross-sectional imaging. Ideal candidates for curative intent surgery are those with epithelioid MPeM, a low peritoneal cancer index, and a good performance status. Contraindications to curative intent surgery include the sarcomatoid MPeM, distant metastases, extensive nodal metastases, and extensive small bowel serosal or mesentery involvement not amenable to complete cytoreduction. Those with biphasic histology, bicavitary disease, and metastatic lymphadenopathy may be considered for surgery following response to neoadjuvant therapy. CRS involves resection of all peritoneal disease, the extent of which varies case by case. Key aspects involve careful evaluation of all peritoneal surfaces, complete parietal peritonectomy and omentectomy, and evaluating suspicious abdominal lymph node basins. Once maximum cytoreduction is achieved, HIPEC is performed using a platinum-based perfusate. Postoperative protocols are recommended to optimize recovery and mitigate HIPEC-specific complications, namely chemotherapy-mediated nephrotoxicity and bone marrow suppression.
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Cytoreduction Surgical Procedures; Lymph Nodes
PubMed: 37673112
DOI: 10.6004/jnccn.2023.7055 -
Journal of the Mechanical Behavior of... Apr 2021A shear-punch test (SPT) experimental method was developed to address the lack of shear deformation and failure response data for the human skull as a function of local...
A shear-punch test (SPT) experimental method was developed to address the lack of shear deformation and failure response data for the human skull as a function of local bone microarchitecture. Improved understanding of skull deformation and fracture under varying stress-states helps implement mechanism-based, multi-axial material models for finite element analysis for optimizing protection strategies. Shear-punch coupons (N = 47 specimens) were extracted from right-parietal and frontal bones of three fresh-frozen-thawed human skulls. The specimens were kept as full through-thickness or segmented into the three skull constituent layers: the inner and outer cortical tables and the middle porous diploë. Micro-computed x-ray tomography (μCT) before and after SPT provided the bone volume fraction (BVF) as a function of depth for correlation to shear mechanisms in the punched volumes. Digital image correlation was used to track displacement of the punch above the upper die to minimize compliance error. Five full-thickness specimens were subjected to partial indentation loading to investigate the process of damage development as a function of BVF and depth. It was determined that BVF dominates the shear yield and ultimate strength of human skull bone, but the imposed uniaxial loading rate (0.001 and 0.1 s) did not have as strong a contribution (p = 0.181-0.806 > 0.05) for the shear yield and ultimate strength of the skull bone layer specimens. Shear yield and ultimate strength data were highly correlated to power law relationships of BVF (R = 0.917-0.949). Full-thickness and partial loaded SPT experiments indicate the diploë primarily dictates the shear strength of the intact structure.
Topics: Bone and Bones; Finite Element Analysis; Frontal Bone; Humans; Porosity; Shear Strength; Skull; Stress, Mechanical
PubMed: 33513459
DOI: 10.1016/j.jmbbm.2021.104343 -
Folia Morphologica 2021The parietal foramen (PF) is a small inconsistent aperture located at the border of the middle 1/3 and posterior 1/3 of the parietal bone near the sagittal suture and is...
BACKGROUND
The parietal foramen (PF) is a small inconsistent aperture located at the border of the middle 1/3 and posterior 1/3 of the parietal bone near the sagittal suture and is considered an emissary foramen. Cranial emissary foramina are of utmost importance due to the structures that traverse the foramen. Variations in these foramina are common. Knowledge of the PF is important when performing neurosurgical procedures as the emissary vessels are at risk.
MATERIALS AND METHODS
The present study used 100 dry adult calvaria to determine the frequency of PF, the diameter of the PF, as well as topography of the PF (using the sagittal suture as an anatomical landmark).
RESULTS
A total of 32% of calvaria had PF present bilaterally; whilst 35% of calvaria had unilateral PF. The study also reports 5% calvaria in which PF were present on the sagittal suture. The mean diameter recorded was 1.55 mm (0.74-3.08 mm), and the mean distance between the lateral margin of the PF and the sagittal suture was 9.02 mm (4.44-18.20 mm).
CONCLUSIONS
Knowledge of the incidence and topography of the PF may aid neurosurgeons in creating and adjusting techniques and procedures in order to mitigate the risk of injury to emissary veins and other structures emerging from the PF.
Topics: Cranial Sutures; Incidence; Parietal Bone; Sphenoid Bone; Veins
PubMed: 33241848
DOI: 10.5603/FM.a2020.0140 -
Mechanical and morphological properties of parietal bone in patients with sagittal craniosynostosis.Journal of the Mechanical Behavior of... Jan 2022Limited information is available on the effect of sagittal craniosynostosis (CS) on morphological and material properties of the parietal bone. Understanding these...
Limited information is available on the effect of sagittal craniosynostosis (CS) on morphological and material properties of the parietal bone. Understanding these properties would not only provide an insight into bone response to surgical procedures but also improve the accuracy of computational models simulating these surgeries. The aim of the present study was to characterise the mechanical and microstructural properties of the cortical table and diploe in parietal bone of patients affected by sagittal CS. Twelve samples were collected from pediatric patients (11 males, and 1 female; age 5.2 ± 1.3 months) surgically treated for sagittal CS. Samples were imaged using micro-computed tomography (micro-CT); and mechanical properties were extracted by means of micro-CT based finite element modelling (micro-FE) of three-point bending test, calibrated using sample-specific experimental data. Reference point indentation (RPI) was used to validate the micro-FE output. Bone samples were classified based on their macrostructure as unilaminar or trilaminar (sandwich) structure. The elastic moduli obtained using RPI and micro-FE approaches for cortical tables (E 3973.33 ± 268.45 MPa and E 3438.11 ± 387.38 MPa) in the sandwich structure and diploe (E1958.17 ± 563.79 MPa and E 1960.66 ± 492.44 MPa) in unilaminar samples were in strong agreement (r = 0.86, p < .01). We found that the elastic modulus of cortical tables and diploe were correlated with bone mineral density. Changes in the microstructure and mechanical properties of bone specimens were found to be irrespective of patients' age. Although younger patients are reported to benefit more from surgical intervention as skull is more malleable, understanding the material properties is critical to better predict the surgical outcome in patients <1 year old since age-related changes were minimal.
Topics: Child; Craniosynostoses; Female; Humans; Infant; Parietal Bone; X-Ray Microtomography
PubMed: 34773914
DOI: 10.1016/j.jmbbm.2021.104929