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Folia Morphologica 2022In the routine anatomic measurement study on Asian dry skulls, a skull of atlanto-occipital fusion with other multiple anatomic variations was observed. The entire right...
In the routine anatomic measurement study on Asian dry skulls, a skull of atlanto-occipital fusion with other multiple anatomic variations was observed. The entire right half of the atlas vertebra, including the anterior arch, anterior tubercle, posterior arch, and lateral masses, was fused entirely with the occipital bone, while the left fused partly. Besides the atlanto-occipital fusion, the target skull specimen also includes posterior arch defects of the atlas, metopic suture, and wormian bones. So many anatomical variations rarely exist in one specimen. This paper aims to present detailed anatomic case reports and discuss related diseases in an anatomic and clinical study.
Topics: Bone and Bones; Cranial Sutures; Foot; Head; Humans; Occipital Bone
PubMed: 34308542
DOI: 10.5603/FM.a2021.0069 -
Pain Physician 2013Stimulation of the greater occipital nerve has been employed for various intractable headache conditions for more than a decade. Still, prospective studies that... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Stimulation of the greater occipital nerve has been employed for various intractable headache conditions for more than a decade. Still, prospective studies that correlate stimulation of the greater occipital nerve with outcome of patients with respect to alleviation of headache are sparsely found in literature.
OBJECTIVE
To identify anatomical landmarks for a reproducible stimulation of the greater occipital nerve. For the clinical implication, the individual response to therapy of patients with refractory chronic cluster headache undergoing occipital nerve stimulation was correlated with the postoperative localization of the electrodes and with the distribution of the stimulation field.
STUDY DESIGN
Prospective observational study, approved by the local research ethics board (09-4143).
SETTING
University hospital, departments of neurosurgery and neurology, institute of anatomy and radiology.
METHODS
Ten formaldehyde fixed human cadavers were dissected to identify the passage of the greater occipital nerve through the trapezius muscle. The distance to the external occipital protuberance was triangulated measuring the distance of the nerve from the nuchal midline and the protuberance. Between December 2008 and December 2011, 21 consecutive patients suffering from chronic cluster headache underwent surgery in terms of bilateral occipital nerve stimulation, with electrodes placed horizontally at the level of C1. The postoperative x-rays were compared with the acquired landmarks from the anatomical study. The distribution of the stimulation field was correlated to the individual response of each patient to the therapy and prospectively analyzed with regard to reduction of daily cluster attacks and relief of pain intensity at 3 months and at last follow-up.
RESULTS
The greater occipital nerve crosses the trapezius muscle at a mean distance of 31 mm below the occipital external protuberance and 14 mm lateral to the midline as found in the anatomical subjects. The electrodes were targeted at this level in all of our patients and stimulated the greater occipital nerve in all patients. Eighteen of the patients (85.7%) reported a significant reduction of the frequency of their cluster attacks and/or declined intensity of pain during the attacks. Yet, 3 of 21 patients (14.3%) did not benefit from the stimulation despite an adequate spread of the stimulation over the occiput. The spread of the stimulation-induced paraesthesias over the occiput was not correlated to a reduction of cluster attacks, to the intensity of attacks, or to the response to treatment at all.
LIMITATIONS
Single center non-randomized non-blinded study.
CONCLUSIONS
From our study we conclude that a reproducible stimulation of the greater occipital nerve can be achieved by placing the electrodes parallel to the atlas, at about 30 mm distance to the external occipital protuberance. The response to the stimulation is not correlated to the field width of the paraesthesia. We, therefore, consider stimulation of the main trunk of the greater occipital nerve to be more important than a large field of stimulation on the occiput. Still, an individual response to the occipital nerve stimulation cannot be predicted even by optimal electrode placement.
Topics: Biophysics; Cadaver; Cluster Headache; Electric Stimulation Therapy; Electrodes; Female; Humans; Magnetic Resonance Imaging; Male; Observation; Occipital Bone; Pain Measurement; Prospective Studies; Retrospective Studies; Spinal Nerves; Time Factors
PubMed: 23703417
DOI: No ID Found -
Journal of Anatomy Oct 1953
Topics: Histological Techniques; Humans; Occipital Bone
PubMed: 13117753
DOI: No ID Found -
World Neurosurgery May 2023Endoscopic transnasal approaches (ETAs) to the ventrolateral skull base are commonly classified according to coronal planes or anatomical structures. Our goal is to...
OBJECTIVE
Endoscopic transnasal approaches (ETAs) to the ventrolateral skull base are commonly classified according to coronal planes or anatomical structures. Our goal is to simplify the description of the ETA to lateral skull base regions in a sequential dissection with correlation to computed tomography, helping in preoperative planning and efficient surgical exposure, and exposing the surgical anatomy limitations.
METHODS
Five freshly injected cadaver heads were dissected using an extended ETA to the lateral skull base. Each specimen underwent a high-resolution computed tomography scan. A classification of the lateral skull base based on well-defined zones was proposed.
RESULTS
We divided the lateral target into four different zones, in a craniocaudal orientation: zone 1 is the space lying between the orbital floor superior and the level of the sellar floor inferior, zone 2 is on the coronal plane, located between the level of the sellar floor and the vidian canal, zone 3 is the area lateral to the anterior limb of the petro-occipital fissure, located between the vidian canal and the carotid canal, and zone 4 is the space located between the carotid canal and the extracranial opening of the hypoglossal canal, lateral to the anterior part of the posterior limb of petro-occipital fissure.
CONCLUSIONS
Multiple previous works have described and classified the coronal plane and its lateral extensions. Our classification system for the proposed lateral zones enables preoperative planning to select a suitable approach. The craniocaudal orientation facilitates the understanding of surgical corridors and tailored exposure.
Topics: Humans; Skull Base; Endoscopy; Orbit; Occipital Bone; Tomography, X-Ray Computed; Cadaver
PubMed: 36842530
DOI: 10.1016/j.wneu.2023.02.093 -
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 -
American Journal of Biological... Mar 2022The anatomical features of the atlanto-occipital joint can be potentially useful in re-associating or excluding crania to atlases in commingled remains. This study...
OBJECTIVES
The anatomical features of the atlanto-occipital joint can be potentially useful in re-associating or excluding crania to atlases in commingled remains. This study investigated whether linear measurements and the 3-dimensional (3D) surface of occipital condyles and articular facets of atlases can represent valid insights for this purpose.
METHODS
The variations among eight corresponding linear distances were analyzed in a sample of 150 individuals through six supervised machine learning techniques attempting to develop classifiers able to identify elements belonging to the same individual. Furthermore, a 3D analysis was conducted on the articular surfaces through superimpositions of 3D models of corresponding and non-corresponding crania and atlases obtained by using respectively stereophotogrammetry and laser scanning. This analysis investigated differences in terms of point-to-point distances (Root Mean Square, RMS) of superimposed 3D surfaces.
RESULTS
None of the six machine learning techniques were able to correctly detect a satisfying percentage of correspondent pairs in the overall sample by using the linear variables. The 3D analysis of the articular surfaces found RMS values over 0.53 mm only for superimposed non-corresponding surfaces, which sets a threshold value to identify 32% of incorrect pairs.
DISCUSSION
The re-association of cranium to atlas proved to be challenging and hardly possible when considering only metric variables. However, the 3D geometry of the articular surfaces represents a valid variable for this purpose and 3D analyses pave the way for an initial exclusion of incorrect re-associations, thus should not be considered as a re-association method per se, but as an exclusionary screening technique.
Topics: Humans; Atlanto-Occipital Joint; Occipital Bone; Photogrammetry
PubMed: 36787652
DOI: 10.1002/ajpa.24437 -
Medicine Feb 2024Complications of rod migration into the occipital bone after upper cervical fusion are very rare. No other cases have been reported, especially when associated with...
RATIONALE
Complications of rod migration into the occipital bone after upper cervical fusion are very rare. No other cases have been reported, especially when associated with destructive spondyloarthropathy (DSA). The purpose of this case report is to remind clinicians of the risk of rod migration in cervical spine surgery in patients with DSA and to provide information on its causes, countermeasures, and treatment.
PATIENT CONCERN
This case report presents the clinical course of a 61-year-old female patient with chronic kidney disease that required hemodialysis.
DIAGNOSIS, INTERVENTION, OUTCOMES
The patient was diagnosed DSA involving the cervical spine. Initial treatment involved a halo vest, followed by anterior cervical corpectomy and fusion spanning from C5 to Th1. However, subsequent complications, including C5 fractures, kyphotic cervical alignment, and rod migration into the occipital bone, lead to multistage surgical interventions. This case highlights the challenges in managing DSA, the significance of optimal fixation strategies, and the importance of accounting for potential alignment changes.
CONCLUSION
The effective management of occipital bone erosion after posterior cervical spine surgery for destructive spondyloarthropathy necessitates meticulous fixation planning, proactive rod length adjustment, preoperative assessment of the occipital position, and consideration of the compensatory upper cervical range of motion to prevent migration-related issues.
Topics: Female; Humans; Middle Aged; Cervical Vertebrae; Fractures, Bone; Occipital Bone; Renal Dialysis; Spinal Fusion; Spondylarthropathies
PubMed: 38363929
DOI: 10.1097/MD.0000000000037143 -
Folia Morphologica 2017Current study examines morphometric alterations of the foramen magnum (FM), occipital condyles (OCs) and hypoglossal canals (HCs) and highlights all the morphometric...
BACKGROUND
Current study examines morphometric alterations of the foramen magnum (FM), occipital condyles (OCs) and hypoglossal canals (HCs) and highlights all the morphometric parameters of the FM area that present side asymmetry, gender dimorphism and are affected by the ageing.
MATERIALS AND METHODS
One hundred and forty-one (73 male and 68 female) Greek adult dry skulls were examined.
RESULTS
Short and long OCs were detected in 27.7% and 26.2%. A combination of short OCs and long HCs was presented in 27.5%. A complete septum was found in 23.6% of the HCs and osseous spurs in 12.9%. Side asymmetry was detected regarding the HCs length (p = 0.046), the maximum extracranial (p = 0.001) and minimum intracranial (p = 0.001) diameters. Mean FM anteroposterior and transverse diameters, FM perimeter and FM surface area were significantly larger in male than in female skulls (p = 0.001 for each parameter). Similarly, the OCs length (right, p = 0.004 and left, p = 0.024) and width (right, p = 0.008 and left, p = 0.006) the left distance HC-OC posterior border (p = 0.048), the anterior (p = 0.011) and posterior (p = 0.001) intercondylar distances and the HCs right length (p = 0.046) were significantly greater in males. A significant decrease was observed with ageing in FM anteroposterior diameter (p = 0.038), FM surface area (p = 0.05), anterior intercondylar distance (p = 0.014) and HC-OC posterior border (p = 0.013).
CONCLUSIONS
The study confirmed that only specific HC dimensions showed side asymmetry (HCs maximum extracranial and minimum intracranial diameters and HCs length), gender dimorphism (HCs right length and left distance HC-OC posterior border) and age influence (HC-OC posterior border and HC left extracranial minimum diameter) among young, adults and elderly individuals. FM and OCs dimensions presented gender dimorphism and the age influenced only FM anteroposterior diameter and surface area and the anterior intercondylar distance. The safe zone of OCs drilling in Greeks, calculated by the distance HC-OC posterior border represents the maximum HC depth and is among the lowest values reported in the literature. The significant decrease of this distance with ageing confirms the existence of a drilling safe zone for young, adults and elder individuals. Regarding OCs length, the same probability exists dealing with a short or a long OC during condylectomy. Before planning a transcondylar approach, the coexistence of short OCs and long HCs should be taken into account. These outcomes will be useful for a safe surgery in the craniocervical region in Greeks.
Topics: Adult; Female; Foramen Magnum; Humans; Male; Middle Aged; Occipital Bone
PubMed: 28150268
DOI: 10.5603/FM.a2017.0002 -
Orthopaedic Surgery Jun 2021The concept of enhanced recovery after surgery (ERAS) has been proposed to provide guidance for the improved postoperative rehabilitation of patients with...
OBJECTIVE
The concept of enhanced recovery after surgery (ERAS) has been proposed to provide guidance for the improved postoperative rehabilitation of patients with occipitocervical region disease (ORD).
METHODS
This study retrospectively investigated 208 consecutive patients (116 men and 92 women) ranging in age from 22 to 76 years with ORD between July 2014 and June 2017 in our medical center, who were divided into three groups that received different preoperative, intraoperative, and postoperative management plans: traditional group (n = 73), ameliorated group (n = 70), and ERAS group (n = 65). We compiled a range of data relating to demographics and postoperative changes in hemoglobin and albumin, surgery duration, intraoperative blood loss, number of postoperative hospitalization days and expenses, readmission rates, and visual analog scale pain symptoms. Data were statistically evaluated using one-way analysis of variance with Student-Newman-Keuls-q post hoc tests or chi-square tests.
RESULTS
There were no significant differences in terms of age (P = 0.235), gender (P = 0.691), body mass index (P = 0.723), American Society of Anesthesiologists grade (0.747), lesion character (P = 0.337) and lesion site (P = 0.957) between the three groups. Within a 6 months follow-up period, there was no significant difference between the three groups in terms of surgery duration (P = 0.225), blood loss (P = 0.172), changes in hemoglobin (P = 0.255) and albumin (P = 0.178). However, postoperative hospitalization days (P = 0.000), postoperative costs (P = 0.019) and improvement of pain symptoms (P = 0.000) in ERAS group were significantly lower or higher than those in traditional group or ameliorated group, respectively. There were 29 (39.73%), 22 (31.43%), and 13 (20.00%), recorded cases of postoperative complications in traditional group, ameliorated group and ERAS group, respectively; complications in ERAS group were significantly lower than those in other two groups (P = 0.043). Moreover, all of the complications were mitigated effectively by the infusion of fluid, analgesia, treatment of infections, or antiemetic medications. There were 2 (2.74%), 3 (4.29%) and 2 (3.08%), recorded cases of re-admission in traditional group, ameliorated group and ERAS group, respectively, but there were no statistically significant differences when compared across the three groups (P = 0.866).
CONCLUSIONS
ERAS can provide benefits when it applied to patients undergoing ORD surgery mainly in terms of reducing postoperative complications, however, ERAS does not increase the economic burden of patients or decrease the risk of readmission.
Topics: Adult; Aged; Brain Hemorrhage, Traumatic; Cervical Vertebrae; Enhanced Recovery After Surgery; Female; Humans; Male; Middle Aged; Occipital Bone; Pain Measurement; Retrospective Studies; Young Adult
PubMed: 33951307
DOI: 10.1111/os.13018 -
Turkish Neurosurgery 2019To identify the range of dimensional morphometric variability correlated to the basilar and condylar part of the occipital bone, which may affect the choice of approach...
Morphometric and Radiomorphometric Study of the Correlation Between the Foramen Magnum Region and the Anterior and Posterolateral Approaches to Ventral Intradural Lesions.
AIM
To identify the range of dimensional morphometric variability correlated to the basilar and condylar part of the occipital bone, which may affect the choice of approach to ventral intradural foramen magnum (FM) lesions.
MATERIAL AND METHODS
In total, 25 dry skulls and 50 head computed tomography (CT) scan results have been assessed in detail, focusing on the FM, occipital condyles, jugular tubercles (JT), and hypoglossal canals (HC). A morphometric analysis has been carried out using linear and angular measurements to estimate the range of the dimensional variability of these structures. Data were presented as mean ± standard deviation, ranges, and interquartile range on a boxplot. The sagittal intercondylar angle (SICA) and anterior condylar angle (ACA) have been found to be important in estimating the axial orientation of the condyles, whereas the JT-HC interline ratio has indicated the prominence of the tubercles.
RESULTS
The SICA and ACA have exhibited high variability. The average JT-HC interline ratio was 0.8. Wider SICA-ACA and higher JT-HC interline ratio make the posterolateral approach advantageous. An anterior medial or far-medial endoscopic route is indicated in opposite conditions. In this study, two illustrative cases have been reported.
CONCLUSION
A cautious preoperative morphometric evaluation of the FM region must be considered prior to using tailored and safe anterior endoscopic and posterolateral approaches to ventral intradural lesions to identify the advantages of a certain corridor as much as possible, thereby minimizing the risk of complications.
Topics: Adult; Dura Mater; Female; Foramen Magnum; Humans; Male; Occipital Bone; Tomography, X-Ray Computed
PubMed: 31452176
DOI: 10.5137/1019-5149.JTN.26052-19.2