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Surgical Neurology International 2024FD is relatively rare in the craniofacial region, accounting for only 20% of all cases. Currently, two general subtypes of FD are recognized: monostotic and polyostotic....
BACKGROUND
FD is relatively rare in the craniofacial region, accounting for only 20% of all cases. Currently, two general subtypes of FD are recognized: monostotic and polyostotic. The monostotic form is more frequent, accounting for 75% to 80% of fibrous dysplasia cases.
CASE DESCRIPTION
An 18-year-old male presented with the complaint of bony-hard swelling over the forehead for 8 years. Radiology showed an expansile osseous lesion involving frontal bones. The patient underwent bi-frontal craniectomy with gross total resection of tumour mass with titanium mesh cranioplasty. His postoperative period was uneventful and was discharged on the seventh postoperative day.
CONCLUSION
The cases of monostotic skull fibrous dysplasia should be treated by resection of the affected bone and cranioplasty. However, a more conservative re-contouring may be carried out in cases with multifocal involvement or when the excision is considered risky due to proximity to the major venous sinuses.
PubMed: 38344095
DOI: 10.25259/SNI_201_2023 -
Journal of Medical Case Reports Feb 2024Osteomas are asymptomatic, benign tumors and are diagnosed accidentally by radiological investigations conducted for other reasons. In some cases, they may cause...
BACKGROUND
Osteomas are asymptomatic, benign tumors and are diagnosed accidentally by radiological investigations conducted for other reasons. In some cases, they may cause aesthetic or functional symptoms by affecting nearby organs. The cause of osteoma is still dialectical. Many theories suggest that inflammation, trauma, or congenital causes are behind its formation. In our case, the patient presented with a symptomatic and huge osteoma in the frontoparietal bone caused by trauma from 18 years ago.
CASE PRESENTATION
A 24-year-old Syrian woman came to our hospital complaining of headaches, syncope episodes, blurred vision, and tumor formation in the frontoparietal region. The medical and surgical histories of the patient revealed appendectomy and head trauma when she was 6 years old in a traffic accident. Radiological investigations showed thickness in the space between the two bone plates in the left frontoparietal region, which reached the orbital roof without cortical destruction or periosteum reaction; the tumor size was 5 cm × 5 cm. A surgical excision was indicated. Under general anesthesia, the surgery was done for the tumor excision. The histopathology examination emphasized the diagnosis of osteoma. The follow-up for 7 months was uneventful.
CONCLUSION
This paper highlights the importance of focusing on the medical history of patients with osteoma in an attempt to explain the reasons for its occurrence. It stresses the need to put osteoma within the differential diagnoses of skull tumors.
Topics: Female; Humans; Young Adult; Bone and Bones; Craniocerebral Trauma; Diagnosis, Differential; Osteoma
PubMed: 38331951
DOI: 10.1186/s13256-024-04373-x -
Ultrasonics Mar 2024Cerebral diseases, such as brain tumors, are intricately linked to the mechanical properties of brain tissues. Estimating the mechanical properties of brain tumors using...
Cerebral diseases, such as brain tumors, are intricately linked to the mechanical properties of brain tissues. Estimating the mechanical properties of brain tumors using transcranial ultrasound is a promising approach. However, the complexity of cranial features introduces challenges, such as ultrasound attenuation and interference from multidirectional transcranial shear waves induced by impact vibrations. To address these issues, this study proposes a transcranial ultrasound estimation method assisted by transcranial shear vibrations. Transcranial vibrations apply shear forces on the parietal bone, inducing unidirectional transcranial shear waves within brain tissue, as validated through simulations. Shear waves at different frequencies were captured via transcranial ultrasound, which were used to assess the viscoelasticity and fluidity of brain tumors. Transcranial experimental validations were conducted in 3D-printed models with tumor phantoms and ex vivo animal tumors. Vibration safety assessments were also performed. The results demonstrate that transcranial ultrasound can detect micron displacements induced by transcranial shear waves. In phantom and ex vivo animal experiments, speed distribution maps were employed to determine the size and location of one or two tumors enclosed in the skull model. The results revealed that the proposed approach could detect tumors with a minimum diameter of 0.8 cm and an inter-tumor distance of 0.8 cm. Notably, significant differences in viscoelasticity and fluidity between normal brain tissue and brain tumors were found (p<0.001). The maximum assessment errors for the elasticity, viscosity, and fluidity using transcranial ultrasound were 11.90%, 4.82%, and 0.73%, respectively, indicating that fluidity was more robust than viscoelasticity. The maximum accelerations of the skull were only 3.21 ms.
Topics: Animals; Elasticity Imaging Techniques; Viscosity; Ultrasonography; Elasticity; Phantoms, Imaging; Brain Neoplasms
PubMed: 38330769
DOI: 10.1016/j.ultras.2024.107262 -
Anthropologischer Anzeiger; Bericht... Jun 2024The (Figueira da Foz, Coimbra, Portugal) is one of at least 21 dolmens in a megalithic complex explored by António dos Santos Rocha between 1880 and 1909. Among the...
The (Figueira da Foz, Coimbra, Portugal) is one of at least 21 dolmens in a megalithic complex explored by António dos Santos Rocha between 1880 and 1909. Among the human remains from Megalitho da Capella is an incomplete and fragmented cranium. Santos Rocha interpreted a groove on the parietal bone as an incision of traumatic origin with signs of remodeling that was suggestive of prolonged survival after an intentional intervention. This study provides a new examination of the groove using microcomputed tomographic (microCT) imaging, microscopy, and macroscopic observations of the groove in addition to the direct dating the skeletal remains. Results indicate that the human remains are dated to the Late Neolithic and that the "incision" is a normal anatomical variant corresponding to impressions from vascular tissue and temporal projections of the squamosal. We conclude that studies of bone surface modifications should consider normal anatomical variants (e.g., sulci, grooves, and furrows) when reporting results. Paleoimaging, microscopy, and comparative observations can assist in the identification bone modifications versus anatomical variants.
Topics: Portugal; Humans; Skull; Anthropology, Physical; X-Ray Microtomography; Fossils
PubMed: 38317614
DOI: 10.1127/anthranz/2024/1771 -
The British Journal of Radiology Mar 2024We retrospectively reviewed the CT and MRI features of patients with benign osteoblastoma in the calvarium and skull base (CSBOB).
OBJECTIVE
We retrospectively reviewed the CT and MRI features of patients with benign osteoblastoma in the calvarium and skull base (CSBOB).
METHODS
Nine cases of pathologically confirmed benign CSBOB were analysed retrospectively. The patients had undergone CT and/or MRI. Tumour location, size, and imaging features were reviewed and recorded.
RESULTS
The patients included four males and five females with a mean age of 27.0 years (age 14-40 years). The tumours were located in the frontal bone in 3 patients, the occipital bone in 3 patients, and in the parietal bone, sphenoid bone, and skull base in 1 patient each. On CT, the tumours measured 5.1 ± 3.3 (1.8-8.4) cm. Seven tumours were shown to have caused expansile bony destruction with an eggshell appearance and varying degrees of calcification or matrix mineralization. Multiple septa were observed in 5 tumours. Intracranial growth was observed in 5 tumours. On MRI, 7 tumours showed heterogeneous hypo- to isointensity on T1WI. Heterogeneous high signal patterns with low signal rims and septa were observed in 6 tumours on T2WI, and 4 showed a fluid-fluid level. On contrast-enhanced imaging, 6 tumours showed peripheral and septal enhancement, and 2 showed the dural tail sign.
CONCLUSIONS
Benign CSBOB is a rare tumour characterized by expansile bony destruction, septa, a sclerotic rim and calcification or matrix mineralization on CT and MRI.
ADVANCES IN KNOWLEDGE
The findings from this study contribute to a better understanding of benign CSBOB and provide valuable imaging features that can aid in its diagnosis and differentiation from other tumours in the calvarium and skull base.
Topics: Male; Female; Humans; Adult; Adolescent; Young Adult; Osteoblastoma; Retrospective Studies; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Skull Base; Bone Neoplasms
PubMed: 38310336
DOI: 10.1093/bjr/tqae027 -
Journal of Neurosurgery Jul 2024The lenticular was an instrument introduced by Galen to facilitate cutting the bone of the cranium. Illustrations of the instrument first appeared in the 16th century...
OBJECTIVE
The lenticular was an instrument introduced by Galen to facilitate cutting the bone of the cranium. Illustrations of the instrument first appeared in the 16th century during the Renaissance. These illustrations have been widely used, but the instrument's shape seems ill-adapted to its function. Archaeological research in Rimini, Italy, unearthed a similar instrument with a shape that seems more suitable for the function of cutting cranial bone. The object of this study was to evaluate the efficacy of these two instruments for cutting the bone of the cranium.
METHODS
Replicas of the two instruments were obtained. Trepanation was performed in the left parietal region of a sheep's head. In addition, the application of the instruments in the literature was analyzed.
RESULTS
The Roman lenticular cut the cranium with ease. The Renaissance instrument failed to cut the bone and only separated the dura mater from the bone. The lenticular had been used to cut bone up to the 13th century. In contrast, the Renaissance instrument was not used to cut bone but to smooth roughened bony surfaces and to remove spicules of bone that were in contact with the dura.
CONCLUSIONS
Analysis of illustrations in medical publications should be undertaken with the same rigor as applied to analysis of text.
Topics: Animals; Sheep; Skull; History, 16th Century; Humans; History, Ancient; Trephining; Medical Illustration; History, Medieval; Craniotomy
PubMed: 38306649
DOI: 10.3171/2023.11.JNS232042 -
World Neurosurgery Apr 2024Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with...
BACKGROUND
Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines.
METHODS
After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded.
RESULTS
Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%-52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%-28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury.
CONCLUSIONS
Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients.
Topics: Adult; Humans; Retrospective Studies; Prospective Studies; Incidence; Australia; Skull Fractures; Sinus Thrombosis, Intracranial; Brain Injuries, Traumatic
PubMed: 38302002
DOI: 10.1016/j.wneu.2024.01.132 -
The Journal of Craniofacial Surgery Feb 2024Bone defects caused by cancer resection often require postoperative radiotherapy. Although various synthetic polymers have been introduced as graft materials, their...
Bone defects caused by cancer resection often require postoperative radiotherapy. Although various synthetic polymers have been introduced as graft materials, their biological behavior after radiation exposure remains unclear. Here, we investigated how polycaprolactone/hydroxyapatite (PCL/HA) implants respond to therapeutic radiation exposure (in terms of volume and bone regeneration). Four 8 mm diameter calvaria defects were surgically created on the parietal bone of 6 rabbits. PCL/HA implants made of porous, solid, and hybrid polymers were grafted by random placement in each defect. The fourth defect was left untreated. Four weeks after surgery, radiation exposure was conducted weekly for 6 weeks (total: 48 Gy). Micro-computed tomography and histologic analysis were performed at 3 and 6 months, and 6 months postradiation, respectively. The total augmented volumes of all implants showed no significant differences between 3- and 6-months postradiation computed tomography images. In histologic analysis, new bone areas were 0.45±0.11 mm2, 2.02±0.34 mm2, and 3.60±0.77 mm2 in solid, hybrid, and porous polymer grafts, respectively. Bone regeneration was limited to the periphery of the defect in the hybrid and porous polymer grafts, whereas new bone formed inside the porous implant. The total augmented volume of the defect was maintained without significant absorption even after radiation exposure. The PCL/HA implant maintained its structure despite radiation exposure. The porous PCL/HA implant demonstrated excellent bone regeneration, followed by the hybrid and solid implants. The PCL/HA implant is a promising candidate for bone defect reconstruction.
PubMed: 38299842
DOI: 10.1097/SCS.0000000000009985 -
Operative Neurosurgery (Hagerstown, Md.) Feb 2024"Ping-pong fractures" (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed...
BACKGROUND AND IMPORTANCE
"Ping-pong fractures" (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed bone when the indentation is considerable or cosmetically apparent. Surgical correction of PPF subjects patients to the risks of surgery and general anesthesia. This article and corresponding video demonstrate a novel means of correcting PPF at bedside without surgery or anesthesia. We used a hospital-grade breast pump connected to a custom-fabricated flange to successfully elevate PPF in two neonates.
CLINICAL PRESENTATION
Two moderately preterm infants were noted at birth to have large parietal PPF. To avoid surgical intervention, elevation using a suction device was attempted. A hospital-grade breast pump was used to provide suction. A custom device was fabricated out of a breast pump flange and molded Coloplast Brava® protective seal rings. This device was carefully applied to the skull to exactly match the diameter of the PPF and contour of the bone. Brief (15-30 seconds) periods of suction were applied several times until the PPF was successfully elevated as documented on subsequent computed tomography scans. Both infants achieved excellent cosmetic results with no adverse effects over 24- and 9-month follow-ups, respectively.
DISCUSSION
This technique eliminates the risks of open surgical correction and corrected the PPF without general anesthesia or adverse effects to the infant. While there may be limitations due to patient age and/or location of the PPF, the use of widely available and inexpensive custom-fitted materials with a hospital grade breast pump achieves maximal efficacy without requiring higher negative pressure suction application.
CONCLUSION
Elevation of PPF can be safely achieved in some neonates using readily available equipment: a hospital-grade breast pump, flange, and moldable adherent material. This technique is reasonable to attempt in lieu of surgical elevation.
PubMed: 38299805
DOI: 10.1227/ons.0000000000001054