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BMC Surgery Jan 2021Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement.... (Review)
Review
Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature.
BACKGROUND
Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously.
CASE PRESENTATION
We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free.
CONCLUSIONS
An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Autografts; Bone Neoplasms; Cisplatin; Clinical Protocols; Combined Modality Therapy; Cryotherapy; Doxorubicin; Female; Femoral Neoplasms; Humans; Humerus; Iodine; Neoadjuvant Therapy; Neoplasms, Multiple Primary; Nitrogen; Occipital Bone; Osteosarcoma; Plastic Surgery Procedures; Saline Solution; Skull Neoplasms; Transplantation, Autologous
PubMed: 33482784
DOI: 10.1186/s12893-020-01018-w -
Pediatric Radiology Jul 2022Achondroplasia is the most common skeletal dysplasia. A significant complication is foramen magnum stenosis. When severe, compression of the spinal cord may result in...
BACKGROUND
Achondroplasia is the most common skeletal dysplasia. A significant complication is foramen magnum stenosis. When severe, compression of the spinal cord may result in sleep apnea, sudden respiratory arrest and death. To avoid complications, surgical decompression of the craniocervical junction is offered in at-risk cases. However, practice varies among centres. To standardize magnetic resonance (MR) reporting, the achondroplasia foramen magnum score was recently developed. The reliability of the score has not been assessed.
OBJECTIVE
To assess the interobserver reliability of the achondroplasia foramen magnum score.
MATERIALS AND METHODS
Base of skull imaging of children with achondroplasia under the care of Sheffield Children's Hospital was retrospectively and independently reviewed by four observers using the achondroplasia foramen magnum score. Two-way random-effects intraclass coefficient (ICC) was used to assess inter- and intra-observer reliability.
RESULTS
Forty-nine eligible cases and five controls were included. Of these, 10 were scored normal, 17 had a median score of 1 (mild narrowing), 11 had a median score of 2 (effacement of cerebral spinal fluid), 10 had a score of 3 (compression of cord) and 6 had a median score of 4 (cord myelopathic change). Interobserver ICC was 0.72 (95% confidence interval = 0.62-0.81). Intra-observer ICC ranged from 0.60 to 0.86. Reasons for reader disagreement included flow void artefact, subtle T2 cord signal and myelopathic T2 cord change disproportionate to canal narrowing.
CONCLUSION
The achondroplasia foramen magnum score has good interobserver reliability. Imaging features leading to interobserver disagreement have been identified. Further research is required to prospectively validate the score against clinical outcomes.
Topics: Achondroplasia; Child; Constriction, Pathologic; Foramen Magnum; Humans; Infant; Reproducibility of Results; Retrospective Studies
PubMed: 35396670
DOI: 10.1007/s00247-022-05348-0 -
Acta Neurochirurgica Mar 2022Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous...
OBJECTIVE
Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws. In the largest case series to date, this paper aims to evaluate the safety profile and complications of condylar screw fixation for occipitocervical fusion.
METHODS
A retrospective safety and complication-based analysis of occipitocervical fusion via condylar screws fixation was performed.
RESULTS
A total of 250 patients underwent occipitocervical fusions using 500 condylar screws between September 2012 and September 2018. No condylar screw pullouts, or vertebral artery impingements were observed in this series. The sacrifice of condylar veins during the dissection at C0-1 did not cause any venous stroke. Hypotrophic condyles were found in 36.4% (91 of the 250) cases and did not prevent the insertion of condylar screws. Two transient hypoglossal deficits occurred at the beginning of this surgical series and were followed by recovery a few months later. Corrective strategies were effective in preventing further hypoglossal injuries.
CONCLUSIONS
This surgical series suggests that the use of condylar screws fixation is a relatively safe and reliable option for OC fusion in both adult and pediatric patients. Methodical dissection of anatomical landmarks, intraoperative imaging, and neurophysiologic monitoring allowed the safe execution of the largest series of condylar screws reported to date. Separate contributions will follow in the future to provide details about the long-term clinical outcome of this series.
Topics: Adult; Bone Screws; Cervical Vertebrae; Child; Humans; Occipital Bone; Retrospective Studies; Spinal Fusion; Surgeons
PubMed: 34820740
DOI: 10.1007/s00701-021-05039-z -
Ear, Nose, & Throat Journal Jun 2023A congenital mastoid cholesteatoma (CMC) is a keratinizing epithelium originating from embryological epithelial tissue of the mastoid. It is often not diagnosed until it...
A congenital mastoid cholesteatoma (CMC) is a keratinizing epithelium originating from embryological epithelial tissue of the mastoid. It is often not diagnosed until it becomes large because of its rarity and indolent nature. Although there are a few reports on giant CMC, its exact extensions have not been well described, and detailed information regarding surgical methods is lacking, especially in giant CMC involving the occipital condyle and the middle and posterior cranial fossae. In this article, we report a case involving a 70-year-old woman with a giant CMC that extended inferiorly to the occipital condyle. The CMC eroded the middle and posterior cranial fossae, sigmoid sinus plate, and fallopian canal of the facial nerve. For complete removal, we used a subtotal petrosectomy in conjunction with an exposure of the cranial cervical junction and a wide decompression of the suboccipit. The boundaries of exposure were similar to those of a petro-occipital transsigmoid approach which is usually used for management of tumor involving the jugular foramen. The wide exposure allowed for complete removal of the lesion without any complications. Thus, we recommend this surgical approach for management of the giant CMC involving the occipital condyle and the middle and posterior cranial fossae.
Topics: Female; Humans; Aged; Mastoid; Occipital Bone; Cholesteatoma, Middle Ear; Cholesteatoma; Cranial Fossa, Posterior
PubMed: 33866866
DOI: 10.1177/01455613211007943 -
Journal of Bone and Mineral Research :... Feb 2016Head injuries resulting from motor vehicle crashes (MVC) are extremely common, yet the details of the mechanism of injury remain to be well characterized. Skull...
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.
Topics: Adult; Aged; Aged, 80 and over; Aging; Brain Injuries; Female; Frontal Bone; Humans; Male; Middle Aged; Occipital Bone; Parietal Bone; Sex Characteristics; Skull Fractures; Tomography, X-Ray Computed
PubMed: 26255873
DOI: 10.1002/jbmr.2613 -
Yonsei Medical Journal Jun 1991Osteoclastoma of the calvarial bone of membranous origin is a rare entity. This paper presents a case of osteoclastoma of the occipital bone and a brief review of... (Review)
Review
Osteoclastoma of the calvarial bone of membranous origin is a rare entity. This paper presents a case of osteoclastoma of the occipital bone and a brief review of literature.
Topics: Child; Giant Cell Tumors; Humans; Male; Occipital Bone; Skull Neoplasms
PubMed: 1949919
DOI: 10.3349/ymj.1991.32.2.169 -
JAMA Facial Plastic Surgery Jan 2018Incision placement and design in rhytidectomy is critical for patient satisfaction. (Comparative Study)
Comparative Study
IMPORTANCE
Incision placement and design in rhytidectomy is critical for patient satisfaction.
OBJECTIVE
To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) trichophytic closure techniques on posterior occipital hairline scars in rhytidectomy.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort study was conducted at the Buckingham Center for Facial Plastic Surgery. Clinical history and operative reports were reviewed for 46 patients who underwent rhytidectomy (23 using W-plasty and 23 using SL technique) between June 1, 2014 and August 31, 2015. Blinded photographic analysis of 1-year postoperative photographs was performed.
INTERVENTIONS
The posterior occipital hairline incision was primarily closed with either a W-plasty or SL trichophytic technique.
MAIN OUTCOMES AND MEASURES
Standard photographs of the posterior occipital incision site obtained after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 3 nonphysician medical staff members using a modified Manchester Scar Scale (MSS: from 0 [best possible outcome] to 24 [worst possible outcome]). Interrater reliability was assessed via Cronbach α testing.
RESULTS
There were 23 patients in each group. The W-plasty and SL groups were similar in terms of age (mean [SD] age, 59.6 [6.3] years and 64.1 [7.3] years, respectively), sex (21 [91%] and 21 [91%] women, respectively), race-ethnicity, and absence of risk factors (smoking and diabetes) predisposing to poor wound healing (0 and 0 smoking/diabetes, respectively). Mean (SD) follow-up times for the W-plasty and SL groups were 388 (38.8) and 475 (100.1) days, respectively. No statistical difference was demonstrated in the mean aggregate MSS scores from all evaluators between the W-plasty group and the SL group (reviewer 1: 5.69 vs 5.86, P = .60; reviewer 2: 10.09 vs 9.56, P = .65; and reviewer 3: 5.30 vs 6.17, P = .08). Overall interrater reliability for the MSS scores was 0.56.
CONCLUSION AND RELEVANCE
Primary W-plasty and SL trichophytic closures in the posterior occipital hairline appear to yield highly acceptable and similar cosmetic outcomes under objective blinded evaluation. These techniques can be used with success to help minimize conspicuous scarring after rhytidectomy.
LEVEL OF EVIDENCE
3.
Topics: Aged; Cicatrix; Esthetics; Female; Follow-Up Studies; Hair; Humans; Male; Middle Aged; Occipital Bone; Outcome Assessment, Health Care; Patient Satisfaction; Photography; Postoperative Complications; Retrospective Studies; Rhytidoplasty; Single-Blind Method; Wound Closure Techniques
PubMed: 28837737
DOI: 10.1001/jamafacial.2017.0644 -
Acta Neurochirurgica Jul 2010The pathogenesis of Chiari malformations is incompletely understood. We tested the hypothesis that different etiologies have different mechanisms of cerebellar tonsil...
BACKGROUND
The pathogenesis of Chiari malformations is incompletely understood. We tested the hypothesis that different etiologies have different mechanisms of cerebellar tonsil herniation (CTH), as revealed by posterior cranial fossa (PCF) morphology.
METHODS
In 741 patients with Chiari malformation type I (CM-I) and 11 patients with Chiari malformation type II (CM-II), the size of the occipital enchondrium and volume of the PCF (PCFV) were measured on reconstructed 2D-CT and MR images of the skull. Measurements were compared with those in 80 age- and sex-matched healthy control individuals, and the results were correlated with clinical findings.
RESULTS
Significant reductions of PCF size and volume were present in 388 patients with classical CM-I, 11 patients with CM-II, and five patients with CM-I and craniosynostosis. Occipital bone size and PCFV were normal in 225 patients with CM-I and occipitoatlantoaxial joint instability, 55 patients with CM-I and tethered cord syndrome (TCS), 30 patients with CM-I and intracranial mass lesions, and 28 patients with CM-I and lumboperitoneal shunts. Ten patients had miscellaneous etiologies. The size and area of the foramen magnum were significantly smaller in patients with classical CM-I and CM-I occurring with craniosynostosis and significantly larger in patients with CM-II and CM-I occurring with TCS.
CONCLUSIONS
Important clues concerning the pathogenesis of CTH were provided by morphometric measurements of the PCF. When these assessments were correlated with etiological factors, the following causal mechanisms were suggested: (1) cranial constriction; (2) cranial settling; (3) spinal cord tethering; (4) intracranial hypertension; and (5) intraspinal hypotension.
Topics: Adult; Arnold-Chiari Malformation; Cranial Fossa, Posterior; Encephalocele; Female; Humans; Male; Middle Aged; Occipital Bone; Radiography
PubMed: 20440631
DOI: 10.1007/s00701-010-0636-3 -
Folia Morphologica 2023The foramen magnum is the largest opening at the base of the skull. The dimensions of the foramen magnum are of significant clinical importance because of the vital...
BACKGROUND
The foramen magnum is the largest opening at the base of the skull. The dimensions of the foramen magnum are of significant clinical importance because of the vital structures that pass through it. The aim of the study was the morphometric analysis of the foramen magnum in children based on head computed tomography (CT).
MATERIALS AND METHODS
The study was carried out on 84 CTs of the head of children aged 0-18 years; seven age groups were distinguished. The sagittal and transverse dimensions were measured to determine the growth rate, changes between groups, and differences in the foramen size by sex. Statistical analysis of changes was performed.
RESULTS
The entire group's mean transverse and sagittal dimensions were 29.08 mm (standard deviation [SD] 3.4 mm) and 35.63 (SD 4.23) mm. By sex, the mean transverse dimension in girls was 28.53 (SD 3.25) mm, and in boys, 29.6 (SD 3.49) mm. The mean sagittal dimension was 35.15 (SD 3.76) mm in girls and 36.09 (SD 4.64) mm in boys. Both dimensions were higher for the male sex. A statistically significant increase in the foramen magnum size was demonstrated up to the age of 36 months in the following age groups; above that age, the increase was statistically insignificant.
CONCLUSIONS
The dimensions were similar to those described in adults a moderate dependence of the foramen magnum size on age was found.
Topics: Adult; Female; Humans; Male; Child; Foramen Magnum; Skull; Tomography, X-Ray Computed; Head
PubMed: 35818806
DOI: 10.5603/FM.a2022.0066 -
BMC Musculoskeletal Disorders Feb 2020Occipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure.
BACKGROUND
Occipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure.
CASE PRESENTATION
We described a patient who underwent OC fusion and subsequently developed complication of cerebellar abscess and obstructive hydrocephalus. A 63-year-old male patient had been suffering from long-term neck pain and limb numbness and weakness. Cervical spine examination revealed tight stenosis at C1 level and instability in the C1-C2 joints. A C1 laminectomy with OC fusion was performed, and the patient was discharged. Unfortunately, a few days later, he went to the emergency department and complained of persistent dizziness, vomiting, and unsteady gait. Computed tomography (CT) and magnetic resonance imaging (MRI) images revealed a suspicious cerebellar abscess formation and hydrocephalus. Furthermore, CT images indicated that the left screw was loose, and the diameter of the right screw hole was much larger than the size of the screw. Besides, inappropriate length of the screw penetrated the occipital bone and may cause the disruption of dura mater. The patient underwent external ventricular drainage first, followed by abscess drainage and C1-C2 fixation a few days later. He was discharged without any further neurological deficits or infectious problems. The patient recovered with intact consciousness, full muscle strength, and improved numbness throughout the extremities, with a Nurick grade of 1. A follow-up magnetic resonance imaging at 3 months after surgery revealed near total resolution of the abscess. Inform consent was obtained from this patient.
CONCLUSIONS
Carefully conducting the procedure using the most tailored approach is essential to successful surgery, but this rare complication should always be kept in mind.
Topics: Abscess; Atlanto-Axial Joint; Bone Screws; Cerebellar Diseases; Cerebellum; Cervical Vertebrae; Craniotomy; Debridement; Drainage; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Middle Aged; Neck Pain; Occipital Bone; Postoperative Complications; Spinal Fusion; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32111221
DOI: 10.1186/s12891-020-3157-0