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Anatomy & Cell Biology Mar 2024Transverse basilar cleft (TBC) is an extremely rare variation of the clivus or the basilar part of the occipital bone. In this report, a unilateral transverse basilar...
Transverse basilar cleft (TBC) is an extremely rare variation of the clivus or the basilar part of the occipital bone. In this report, a unilateral transverse basilar fissure was found at the clivus in a head computed tomography of an 18-year-old female patient diagnosed with hemifacial microsomia (HFM). Image analysis of this patient showed shortening of the ramus of the right mandible along with medial displacement of the right temporomandibular joint and hypoplastic right maxilla. In addition, observation of the clivus showed a cleft between the basioticum and basioccipital bones at the level of the pharyngeal tubercle on the right side. This cleft was identified as TBC. Clival variations, TBC included, attributed to HFM have never been reported. This report draws attention to the complex relationship between abnormal development of clivus and HFM syndrome, and sheds light on a possible genetic and molecular association between these two conditions.
PubMed: 38449077
DOI: 10.5115/acb.23.289 -
Anatomy & Cell Biology Jun 2024The jugular foramen (JF) is located between the temporal and occipital bones. The JF is a primary pathway for venous outflow from the skull and passage of nerves....
The jugular foramen (JF) is located between the temporal and occipital bones. The JF is a primary pathway for venous outflow from the skull and passage of nerves. Variations are common in this region and may have clinical and surgical implications. To analyze the sexual dimorphism and JF morphology in skulls from Northeastern Brazil. 128 human skulls from the Anatomy Laboratory of the Federal University of Paraíba, 64 male and 64 female, were selected and the JFs analyzed for bone septation and the presence of a dome. Data analysis considered <0.05 as significant. On at least one side, complete septation was observed in 26 skulls (20.3%), incomplete septation in 93 skulls (72.6%) and 61 skulls (47.6%) did not present septation. In 114 skulls (89%), 47.6% female and 41.4% male, have a unilateral presence of the dome and 71 (55.4%) have it bilaterally. Posterolateral compartment diameters and JF area had higher values on the right side in the total sample and separated by sex (<0.05). Most morphometric variables of the anteromedial compartment were higher in male than in female (<0.05), fact that was not observed in the posterolateral compartment (>0.05). This study showed a higher prevalence of complete septation in males compared to females. Morphometric analysis presented a peculiar morphology of the JF in this study. These results suggests that the surgical approach to diseases that affect the JF may be peculiar to the studied population, confirming the importance of morphological analysis of the skull base.
PubMed: 38449076
DOI: 10.5115/acb.23.218 -
[Rinsho Ketsueki] the Japanese Journal... 2024A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after...
A 63-year-old man with adult T-cell leukemia-lymphoma underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor. On day 17 after transplantation, chest computed tomography (CT) showed nodules in the lower lobes of both lungs, and invasive pulmonary aspergillosis (IPA) was suspected. Treatment with liposomal amphotericin B was started, and improvement of infectious lesions was confirmed with CT on day 28. The antifungal agent was changed to voriconazole on day 52 because of progressive renal dysfunction. Disorders of consciousness and paralysis of the left upper and lower extremities developed on day 61. Brain CT showed subcortical hemorrhage in the right parietal and occipital lobes, and the patient died on day 62. An autopsy revealed filamentous fungi, suspected to be Aspergillus, in the pulmonary nodules and a ruptured cerebral aneurysm. Although IPA occurs in 10% of transplant recipients, vigilant monitoring for mycotic cerebral aneurysms is required to prevent hematogenous dissemination of Aspergillus, which is associated with a high mortality rate.
Topics: Adult; Male; Humans; Middle Aged; Intracranial Aneurysm; Leukemia-Lymphoma, Adult T-Cell; Hematopoietic Stem Cell Transplantation; Bone Marrow Transplantation; Lymphoma
PubMed: 38448003
DOI: 10.11406/rinketsu.65.84 -
The Journal of Maternal-fetal &... Dec 2024Sonographic evaluation of the basilar artery is challenging, and a limited number of reports are available about the prenatal period, as manual positioning of probes is...
OBJECTIVES
Sonographic evaluation of the basilar artery is challenging, and a limited number of reports are available about the prenatal period, as manual positioning of probes is technically difficult. The objective of this study was to describe a sonographic transabdominal approach based on slowflow HD for screening of the basilar artery during the second trimester scan.
METHODS
A total of 49 women who were enrolled in a second trimester screening were included when the fetus was in the occipitoanterior position. Dopper screening of the cerebral artery was performed, which revealed the "Y" sign indicating the basilar trunk arising from two vertebral arteries in the axial oblique view when the probe was located around the junction of the vertebral processes and occipital bone and was superior to the first vertebral body, sloping slightly to the cephalic side. The Doppler ultrasound probe was placed perpendicular to the basilar artery. The flow direction was below the baseline, away from the probe in the basilar artery, consistent with a caudocephalic orientation. Peak systolic and diastolic velocities were measured.
RESULTS
The basilar artery was identified in all 49 fetuses, with a mean gestational age of 22 weeks (range 20 to 26 weeks). The mean peak systolic velocity of the basilar artery was 15.8 cm/second (range 9.12-26.44 cm/second). There was a slight increase in peak systolic velocity according to the gestational age of the fetus.
CONCLUSIONS
This study demonstrated that evaluation of the basilar artery can be performed during the second trimester a new transabdominal approach involving slowflow HD.
Topics: Humans; Pregnancy; Female; Infant; Pregnancy Trimester, Second; Basilar Artery; Angiography; Diastole; Fetus
PubMed: 38442990
DOI: 10.1080/14767058.2024.2326302 -
World Neurosurgery May 2024This study aimed to examine pneumatization and topographic location of the posterior clinoid process (PCP) in Chiari type I malformation (CIM) for skull base approaches.
OBJECTIVE
This study aimed to examine pneumatization and topographic location of the posterior clinoid process (PCP) in Chiari type I malformation (CIM) for skull base approaches.
METHODS
Computed tomography images of 52 (23 males/29 females) CIM subjects aged 23.87 ± 16.09 years and 71 (26 males/45 females) healthy subjects aged 42.48 ± 21.48 years constituted the study universe.
RESULTS
The distances of PCP to the foramen magnum (P = 0.037), superior orbital fissure (P < 0.001), foramen rotundum (P < 0.001), and foramen ovale (P < 0.001) were smaller, but the distance of PCP to the crista galli (P = 0.038) was greater in CIM patients, compared with normal subjects. In CIM, the fusion between PCP and the anterior clinoid process was observed in 9 sides (8.70%), while in controls it was observed in 12 sides (8.50%). PCP pneumatization was observed in 40 sides (38.50%) in CIM patients, while it was observed in 28 sides (19.70%) in normal subjects. These data displayed that PCP pneumatization was affected by CIM (P < 0.001).
CONCLUSIONS
The distances of PCP to the crista galli and foramen magnum indicate the anterior fossa length and the posterior fossa depth, respectively; thus CIM patients have a longer anterior fossa and a shallow posterior fossa. In addition, the distances of PCP to the superior orbital fissure, foramen rotundum, and foramen ovale indicate the middle fossa width; hence CIM patients have less middle fossa width than normal individuals. CIM patients have an approximately 50% higher PCP pneumatization rate, and this may increase the risk of complications such as cerebrospinal fluid fistula during the application of posterior clinoidectomy.
Topics: Humans; Arnold-Chiari Malformation; Male; Female; Adult; Young Adult; Tomography, X-Ray Computed; Adolescent; Middle Aged; Skull Base; Foramen Magnum; Sphenoid Bone
PubMed: 38431212
DOI: 10.1016/j.wneu.2024.02.130 -
Journal of Morphology Mar 2024The proatlas, a bone located between the skull and the neural spines of the cervical vertebrae, is best known from reptiles. Most previous studies of the proatlas have...
The proatlas, a bone located between the skull and the neural spines of the cervical vertebrae, is best known from reptiles. Most previous studies of the proatlas have centered on its developmental, debating the relationship between the proatlas and the cervical neural arches. The present study was intended as a description of the proatlas in the American alligator (Alligator mississippiensis) and an experimental test of its hypothesized role in venous blood and cerebrospinal fluid (CSF) distribution. In Alligator, the proatlas is chevron-shaped; ventrally it has a loose connection to the dorsal surface of the first cervical vertebrae, dorsally it has a robust elastic tissue tether on the otoccipital and supraoccipital bones. The ventral surface of the proatlas parallels the dorsal margin of the foramen magnum and rests on the dorsal surface of the spinal venous sinus. Experimental manipulation of the proatlas demonstrated that displacement of the proatlas causes pressure changes in both the spinal venous sinus and the enclosed spinal CSF. The results of this study represent the first demonstration of an explicit functional role for the proatlas, the circulation of fluids between the cranial and spinal compartments of the central nervous system.
Topics: Animals; Cervical Atlas; Cervical Vertebrae; Foramen Magnum; Neck
PubMed: 38424675
DOI: 10.1002/jmor.21683 -
The International Journal of... Mar 2024To report a case of anomalous development of base of skull (platybasia, Basilar invagination and C1-C2 vertebral fusion); and emphasize nonsurgical management in...
AIM
To report a case of anomalous development of base of skull (platybasia, Basilar invagination and C1-C2 vertebral fusion); and emphasize nonsurgical management in inoperable cases that can improve quality of life of the patient.
MATERIALS AND METHODS
The case is reported as a descriptive study of a 17-year-old female who presented to a rural teaching tertiary care hospital in Wardha, Maharashtra, India; with chief complaints of weakness in all four limbs since 10 years of age.
RESULT AND CONCLUSION
Platybasia is a developmental defect of the occipital bone and upper cervical spine resulting from anomalous development. The mechanism of such anomalies is not known; however, the most accepted theory includes abnormal basi-occiput development. The pressure effects may present signs similar to progressive spastic paralysis, cerebellar symptoms, or cranial nerve palsy, in addition to musculoskeletal symptoms. It is, therefore, crucial for physicians and radiologists to be familiar with clinical manifestations and radiological findings. In the following case of a patient with base of skull anomalies, surgical intervention in view of progressive worsening of motor symptoms was advised, however, the guardians declined the same due to high risk involved. Due to financial constraints, genetic studies were unaffordable, and a lack of awareness regarding the disease hampered the guardians from making a decision on the definite management of the disease. Besides radical neurosurgery, intensive physiotherapy can prove vital in significantly improving the quality of life for the patient.
PubMed: 38421185
DOI: 10.1080/00207454.2024.2311234 -
Anatomy & Cell Biology Jun 2024Essential sources of arterial vascularisation in the head and neck region are the left and right common carotid arteries (CCA) and their branches. The left CCA (LCCA)...
Essential sources of arterial vascularisation in the head and neck region are the left and right common carotid arteries (CCA) and their branches. The left CCA (LCCA) originates from the arch of the aorta and the right CCA originates from the brachiocephalic trunk. In this case report, there was a bilateral higher division of CCA at the plane of the greater cornua of the hyoid bone, unilateral tri-ramification of the LCCA and the left external carotid artery (LECA), and the origin of the linguo-facial trunk and the pharyngo-occipital trunk from the LECA. An aneurysm formed in the distal part of LECA before its termination. In this case, we propose a novel categorization called the punnapatla classification for the anatomical variance branching forms of ECA. These kinds of variations are important to the surgeons, and anaesthetists, during the surgeries of the head and neck.
PubMed: 38415313
DOI: 10.5115/acb.23.306 -
Seminars in Ophthalmology Jul 2024This study investigates the new combined parameters of Tc-DTPA orbital single-photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of...
New Multi-Parameters Combination of Technetium-99m-Diethylene-Triamine-Pentaacetate Orbital Single-Photon Emission Computed Tomography/Computed Tomography for the Evaluation of Graves' Orbitopathy Activity.
PURPOSE
This study investigates the new combined parameters of Tc-DTPA orbital single-photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of Graves' orbitopathy (GO) activity.
METHODS
A retrospective analysis was performed on 41 patients. All the patients undergone the 99mTc-DTPA orbital SPECT/CT and were categorized into active and inactive group based on the standard combined by the clinical active score (CAS), magnet resonance imaging (MRI) and/or follow-up results. Quantitative parameters of lacrimal gland (LG) including the protruding degree of lacrimal gland herniation (LGH) and uptake ratios (URs) of region of interest (ROI) drawn on lacrimal gland and occipital bone. SPECT/CT reading results were based on visual analysis. Parameters were compared between the two groups and the diagnostic value on discrimination of GO activity was also evaluated.
RESULTS
All parameters of SPECT/CT for active GO groups were significantly higher than those of the inactive groups (<.05). There were notable linear positive correlations between the assumption standard and readings as well as combination models 2 and 3 ( = .794, = .772, = .760, respectively). ROC analysis indicated that model 2 provided the highest diagnostic performance, exhibiting an area under the curve (AUC) of .947, a sensitivity of 92.7%, and a specificity of 88.6%.
CONCLUSIONS
The combined use of SPECT/CT reading results and DTPA uptake parameters of LG offers a more objective and precise evaluation of active GO. This study further recommends Tc-DTPA SPECT/CT might be serving as a supplementary beneficial approach for CAS in evaluating GO activity.
Topics: Humans; Male; Female; Retrospective Studies; Graves Ophthalmopathy; Middle Aged; Radiopharmaceuticals; Adult; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pentetate; Aged; Orbit; ROC Curve; Lacrimal Apparatus
PubMed: 38411131
DOI: 10.1080/08820538.2024.2324070 -
Orthodontics & Craniofacial Research Aug 2024This study aimed to assess the relative growth rates (RGRs) of the maxilla and mandible at varying fusion stages of the spheno-occipital synchondrosis (SOS), thereby...
OBJECTIVES
This study aimed to assess the relative growth rates (RGRs) of the maxilla and mandible at varying fusion stages of the spheno-occipital synchondrosis (SOS), thereby elucidating the potential of SOS stages in predicting maxillomandibular growth.
MATERIALS AND METHODS
A total of 320 subjects (171 boys and 149 girls), aged 6 to 18 years, were retrospectively included. Each subject had a minimum of two longitudinal cone-beam computed tomography (CBCT) images, with no more than one interval of SOS fusion stage change between the two scans. Subjects were categorized based on their SOS fusion stages and genders. The RGRs of the maxilla and mandible at various SOS fusion stages were measured and compared using longitudinal CBCT images.
RESULTS
Significant statistical differences were observed in maxillomandibular RGRs across various SOS fusion stages. In girls, the sagittal growth of the maxilla remained stable and active until SOS 3, subsequently exhibited deceleration in SOS 4-5 (compared to SOS 3-4, P < .05) and continued to decrease in SOS 5-6. Whereas in boys, the sagittal growth of the maxilla remained stable until SOS 4, and a deceleration trend emerged starting from SOS 5 to 6 (P < .01 compared to SOS 4-5). Mandibular growth patterns in both genders exhibited a progression of increasing-accelerating-decelerating rates from SOS 2 to 6. The highest RGRs for total mandibular length were observed in SOS 3-4 and SOS 4-5.
CONCLUSION
Spheno-occipital synchondrosis fusion stages can serve as a valid indicator of maxillomandibular growth maturation.
Topics: Humans; Male; Female; Child; Adolescent; Cone-Beam Computed Tomography; Longitudinal Studies; Mandible; Occipital Bone; Maxilla; Retrospective Studies; Sphenoid Bone; Feasibility Studies; Maxillofacial Development; Cephalometry; Sex Factors
PubMed: 38409951
DOI: 10.1111/ocr.12774