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Revista de Neurologia Apr 2015Growing skull fracture, also known as post-traumatic bone absorption or leptomeningeal cyst, is a rare complication of traumatic brain injuries and occurs almost... (Review)
Review
INTRODUCTION
Growing skull fracture, also known as post-traumatic bone absorption or leptomeningeal cyst, is a rare complication of traumatic brain injuries and occurs almost exclusively in children under 3 years of age.
CASE REPORT
We report the case of a 6-month-old child who presented, two months after an apparently unimportant traumatic skull injury, persistence of left temporoparietooccipital cephalohaematoma with no other signs. A transfontanellar ultrasonography scan revealed a bone defect with brain herniation, and computerised tomography and magnetic resonance imaging also confirmed the existence of a growing fracture. Excision of the leptomeningeal cyst, dural closure and repair of the bone defect with plates and lactate material were performed. Three months after the operation, the patient still presented collection of fluid and recurrence of the growing fracture was confirmed. Following the second operation, a baby helmet was fitted in order to prevent renewed recurrences. One year after the traumatic injury occurred, the patient remains asymptomatic.
CONCLUSIONS
Any child under 3 years of age with a post-traumatic cephalohaematoma should be checked periodically until the full resolution of the collection of fluid, especially if they present a fractured skull. The presence of a cephalohaematoma that remains more than two weeks after traumatic brain injury must make us suspect a growing fracture and reparation of the dura mater and a cranioplasty will be needed to treat it. The use of resorbable material allows it to be remodelled as the patient's skull grows, but its fragility increases the risk of recurrence. The use of a baby helmet after the operation could prevent complications.
Topics: Absorbable Implants; Accidental Falls; Arachnoid Cysts; Craniocerebral Trauma; Disease Progression; Dura Mater; Encephalocele; Head Protective Devices; Hematoma, Epidural, Cranial; Humans; Imaging, Three-Dimensional; Infant; Magnetic Resonance Imaging; Male; Occipital Bone; Parietal Bone; Prostheses and Implants; Plastic Surgery Procedures; Recurrence; Skull Fractures; Tomography, X-Ray Computed
PubMed: 25857859
DOI: No ID Found -
Neurologia Medico-chirurgica 2011Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The... (Comparative Study)
Comparative Study
Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.
Topics: Adult; Aged; Anthropometry; Atlanto-Occipital Joint; Biomechanical Phenomena; Humans; Middle Aged; Occipital Bone; Radiography; Spinal Fusion
PubMed: 22027245
DOI: 10.2176/nmc.51.701 -
Annals of Neurology Feb 2022A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper... (Observational Study)
Observational Study
OBJECTIVE
A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS).
METHODS
From a single-center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12-year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion.
RESULTS
Patients who developed SPMS showed faster cord atrophy rates (-2.19%/yr) at least 4 years before conversion compared to their RRMS matches (-0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (-1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (-1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively.
INTERPRETATION
Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268-281.
Topics: Adult; Atrophy; Brain; Disease Progression; Female; Foramen Magnum; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Sclerosis, Relapsing-Remitting; Predictive Value of Tests; Prognosis; Prospective Studies; Spinal Cord
PubMed: 34878197
DOI: 10.1002/ana.26281 -
Folia Morphologica 2021Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of...
BACKGROUND
Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of occipital neuralgia. This study proposed to investigate the location of GON subcutaneous (Sc) and semispinalis capitis (SSC) piercing points related to the intermastoid and external occipital protuberance (EOP) to mastoid process (MP) lines.
MATERIALS AND METHODS
The Sc piercing point, relation to SSC and obliquus capitis inferior (OCI) muscles of 100 GONs from 50 cadaveric heads (23 males, 27 females) were dissected. Distances from EOP to MP (EM line) on both sides and between MPs (MM line) were measured. Perpendicular lines from Sc and SSC piercing points to EM and MM lines were created and measured. Distances from EOP to the perpendicular lines of SSC piercing point and from MP to the perpendicular lines of Sc piercing point were measured and calculated into percentage of EM and MM length, respectively.
RESULTS
Three types of Sc piercing points (I, II and III) were obtained. The percentage of GON piercing trapezius muscle (TP) (type I), aponeurosis of TP (type II) and aponeurosis between TP and sternocleidomastoid muscle (SCM) (type III) were 2, 67 and 31, respectively. In addition, 95% of GON pierced SSC, 2% pierced its tendinous band and 3% travelled between its medial fibres and the nuchal ligament. 94% of the GON turned around the lower edge of the OCI, while 6% pierced the lower edge of this muscle. Sc piercing point was always located above the MM line, but it could be above, below or on the EM line. In contrast, all of the SSC piercing points were located below the EM line except in one specimen, but it could be above, below or on the MM line. Therefore, the MM and EM lines were used as reference lines for locating the Sc and SSC piercing points, respectively. The mean EM line length was 81.26 ± 5.26 mm with statistically significant differences between genders and sides in female. The mean MM line length was 121.77 ± 8.54 mm with a statistically significant difference between genders. Sc piercing point could be located at 44% of MM line length from ipsilateral MP with a mean vertical distance of 18 mm. No statistically significant difference was found between genders and sides in these parameters, but a statistically significant difference was found in the percentage of MB to MM line between type III and type I (p = 0.02). SSC piercing point of all types could be located at the point of 25% of EM line length from EOP with a vertical distance of 18 mm below EM line. No statistically significant difference was found between genders, sides and types of both piercing points.
CONCLUSIONS
MM and EM lines are potential reference lines for locating the Sc and SSC piercing points of GON, respectively.
Topics: Female; Head; Humans; Male; Mastoid; Neck; Neck Muscles; Occipital Bone
PubMed: 32844388
DOI: 10.5603/FM.a2020.0099 -
European Spine Journal : Official... Aug 2009The objective of this article is to display the vertebral artery and bone structure at the craniocervical junction (CJVA and C(0-1-2)) with three-dimensional CT...
The objective of this article is to display the vertebral artery and bone structure at the craniocervical junction (CJVA and C(0-1-2)) with three-dimensional CT angiography (3DCTA) and identify their anatomic features and variations. Eighty-eight subjects without pathology of vertebral artery (VA) and C(0-1-2) were selected from head-neck CTA examination. 3D images were formed with volume rendering (VR) and multiplanar reconstruction (MPR). On the 3D images, CJVA and C(0-1-2) were measured, and their variations were observed. CJVA goes along C(0-1-2) with five curves, of which three curves are visibly away from C(0-1-2), one is 0.0-8.3 mm away at the second curve with 0.0-11.2 mm in width, another is 0.0-9.2 mm away at the fourth with 2.8-14.8 mm and the other is 0.0-6.2 mm away at the fifth. Statistical comparisons show that there is no significant difference in the measurements between left and right, and that the curves become smaller and farther away from C(0-1-2) with the increase of age. CJVA is not equal in size, with the biggest in the fourth curve and the smallest in the fifth. Statistical comparison shows the left CJVA is larger than the right in the fifth curve. Variations were found on CJVA in 16 cases and on C(1) in 12 cases. The anatomy and variations of CJVA and C(0-1-2) are complicated. It is of vital significance to identify their anatomic features in clinical practice.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Axis, Cervical Vertebra; Bone and Bones; Cervical Atlas; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Occipital Bone; Tomography, X-Ray Computed; Vertebral Artery; Young Adult
PubMed: 19288143
DOI: 10.1007/s00586-009-0925-9 -
The Angle Orthodontist 1997
Topics: Cephalometry; Cranial Sutures; Humans; Malocclusion; Maxillofacial Development; Occipital Bone; Sella Turcica; Sphenoid Bone
PubMed: 9107370
DOI: 10.1043/0003-3219(1997)067<0083:MSOC>2.3.CO;2 -
BMC Oral Health Dec 2022This study aimed to compare spheno-occipital synchondrosis (SOS) maturation stages with a three-dimensional assessment of mandibular growth.
BACKGROUND
This study aimed to compare spheno-occipital synchondrosis (SOS) maturation stages with a three-dimensional assessment of mandibular growth.
METHODS
This is a cross-sectional study of a retrospective type, in which cone-beam computed tomography (CBCT) images of 500 patients aged 6 to 25 years (226 males and 274 females) were analyzed. The SOS was evaluated using the four-stage scoring system; completely open, partially fused, semi-fused, or completely fused. The SOS scoring and three-dimensional cephalometric measurements were analyzed by Invivo 6.0.3 software. Descriptive and analytical statistics were performed, and a P-value < 0.05 was considered statistically significant.
RESULTS
There was a statistically significant difference in mandibular measurements among SOS maturation stages in both sexes (P < 0.05). The skeletal growth increments of mandibular variables across the SOS stages had higher mean differences between SOS stages 2 and 3 than those between stages 1 and 2 and stages 3 and 4 in both sexes. The mandibular growth curves increased with chronological age (earlier in females) and SOS maturation stages (mostly in stages 1, 2, and 3 than stage 4).
CONCLUSIONS
The SOS maturation stages are valid and reliable mandibular skeletal indicators as evaluated with three-dimensional cephalometric mandibular measurements. The findings of growth increments and constructed growth curves of mandibular growth might be helpful in diagnosis and treatment planning.
Topics: Male; Female; Humans; Occipital Bone; Sphenoid Bone; Retrospective Studies; Cross-Sectional Studies; Mandible; Cone-Beam Computed Tomography
PubMed: 36585639
DOI: 10.1186/s12903-022-02692-3 -
Anais Da Academia Brasileira de Ciencias 2020The modern human has the most flexed cranial base among all living animals. The flexure allowed a larger cranial volume to accommodate a greater brain....
The modern human has the most flexed cranial base among all living animals. The flexure allowed a larger cranial volume to accommodate a greater brain. Spheno-occipitalis synchondrosis (SOS) has been largely responsible for cranial base flexion, between the sphenoid and the Pars basilaris of the occipital bone. The objective of this work is to evaluate the real place of skull base flexure. Analysis based on 50 magnetic resonance imaging from normal adult subjects were used to evaluate normal place for cranial base angulation (CBA). The vertex of the cranial base angle in all individuals occurred intrinsically in the sphenoid bone. In humans, cranial base flexure had a specific pre-chordal origin, rather than in the transition between pre-chordal and chordal plates and occurred in the inner sphenoidal bone.
Topics: Adolescent; Adult; Aged; Child; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Occipital Bone; Skull Base; Sphenoid Bone; Young Adult
PubMed: 32401836
DOI: 10.1590/0001-3765202020190825 -
The Journal of International Medical... Aug 2020Solitary plasmacytoma (SP) of the skull is an uncommon clinical entity that is characterized by a localized proliferation of neoplastic monoclonal plasma cells. This...
Solitary plasmacytoma (SP) of the skull is an uncommon clinical entity that is characterized by a localized proliferation of neoplastic monoclonal plasma cells. This case report describes a 50-year-old male that presented with a headache and an exophytic soft mass on the occiput. The diagnosis of SP was based on the pathological results and imaging examinations. The patient underwent occipital craniotomy, skull reconstruction and lower trapezius myocutaneous flap (LTMF) transplantation under general anaesthesia. The tumour was capsulized and extended to the subcutaneous and the subdural space through the dura mater with skull defects. The neoplasm of the occipital bone involved large areas of scalp and subcutaneous tissue, which resulted in a large postoperative scalp defect that was repaired using LTMF transplantation. All of the tumour was removed and the transplanted flap grew well. Follow-up at 5 months identified an aggressive mass lesion on the right frontal lobe. The patient received six cycles of the PAD chemotherapy regimen (bortezomib, doxorubicin and dexamethasone) and the lesion was significantly reduced. This case demonstrates that LTMF is an alternative approach for the repair of scalp and subcutaneous soft tissue defects caused by the excision of a large malignant tumour of the occipital region. Chemotherapy is the choice of treatment for neoplastic recurrence.
Topics: Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Occipital Bone; Plasmacytoma; Scalp; Surgical Flaps
PubMed: 32780654
DOI: 10.1177/0300060520914817 -
BMJ Case Reports Jan 2017
Topics: Anti-Bacterial Agents; Child, Preschool; Drainage; Female; Humans; Neck Pain; Occipital Bone; Osteomyelitis; Retropharyngeal Abscess; Tomography, X-Ray Computed
PubMed: 28100572
DOI: 10.1136/bcr-2016-217479