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Background: After tumor surgery or traumatic defects the anterior skull base needs sufficient closure in order to prevent rhinoliquorrhea, ascending infection and brain tissue prolaps. Small defects are sufficiently closed by non-vital tissue, e. g. mucosa, muscle, fat, fascia, bone, allogenic, xenogenic or alloplastic material. Larger defects of the skull base often require more extensive surgery, including transfer of local or distal vascularized flaps. The current article presents a stepwise tutorial for reconstruction of the skull base and by a large case series focuses on the interdisciplinary therapy of complex (size, recurrence, after radiotherapy) skull base defects., Material and Method: Complex defects with small diameter, which can occur after extended sinus surgery, were permanently closed by local mucosa flaps of the lower turbinate or of the septum (n=31). Larger defects, e. g. after combined transcranial and endonasal tumor surgery, were closed by a 'sandwich technique' containing a galea periost flap and a calvarian split transfer (n=10). Reconstruction of the dura with fascia lata and local transfer of the temporal muscle were efficient for frontobasal defects with a more lateral location (n=4). Transfer of a distal desepithelialised vascularized forearm flap represents the ultimate procedure for reconstruction of large skull base defects, which was performed in 4 of our patients., Conclusion: Successive escalation of the therapy and integra-tion of the entire repertoire of plastic-reconstructive surgery allows for durable closure of complex skull base defects. In every case, close cooperation between ENT- and neurosurgeons is necessary for planning and performance of a successful surgical procedure., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: Using magnetic resonance (MR) imaging we studied the brace effect in scoliosis in the sagittal plane., Method: In 38 patients with idiopathic scoliosis (mean age 13.4 years) MR total spine imaging was carried out to investigate the immediate effect of bracing in the sagittal plane. There were 19 thoracic, 13 S-shaped and 6 lumbar scoliosis. On conventional radiographs the mean Cobb angle of the thoracic curves was 31 degrees and of the lumbar curves 26 degrees. MR imaging was performed in the supine position with and without the brace in direct sequence. On the sagittal MR projection the Cobb angle was measured between T 4 and T 12 and between T 12 and L 5., Results: On the coronal MR images the mean correction with brace was 23 % of the thoracic curves and 29 % of the lumbar curves. The mean, sagittal Cobb angle (T 4 - T 12) was 14 degrees without brace and 12 degrees with brace. For the lumbar curves the mean sagittal Cobb angle (T 12 - L 5) was 32 degrees without brace and 31 degrees with brace. In the paired t-test these differences were significant., Conclusion: Using MR total spine imaging the brace effect in scoliosis could be depicted in the sagittal plane. In the thoracic spine a correction of the lordotic deformity could not be observed.

Introduction: Alagille syndrome is a dominantly inherited disorder affecting the liver (arteriohepatic dysplasia), the heart, the eyes and the face. Butterfly vertebrae in the thoracic and lumbar spine are detectable in 50 to 80 per cent of the patients; most of them remain asymptomatic. The management of progressive cholestasis in early childhood is the main aspect of therapy., Case: A 14-year-old female patient with Alagille syndrome was referred to our hospital for examination of a right thoracic scoliosis. Magnetic resonance imaging verified butterfly deformity in thoracic vertebrae 2, 4, 6, 7, 8, 10, 11, and lumbar vertebra 3. Asymmetries of thoracic vertebrae 6, 8 and especially, 7 were responsible for the scoliosis., Conclusion: The highly variable expression of these typical characteristics in mildly affected patients can cause some difficulties. When diagnosing a scoliosis with asymmetric butterfly vertebrae, an Alagille syndrome should be considered, especially if the patient shows a liver dysfunction.

Aim: Scoliosis is a spinal deformity that is more complex and does not exist in one plane only. There have been many attempts to analyse three-dimensional spinal deformity, however, these procedures necessitate higher radiation doses., Method: In this study we define angles according to the Cobb Definition. By means of trigonometrical evaluation, 3D calculation of spinal deformity is demonstrated using MRI of the total spine in two reconstructed perpendicular planes. 3D spinal analysis was performed on 41 female and 7 male patients with scoliosis., Results: 79 angles were measured by using the Cobb angle in reconstructed coronal plane of MRI of the total spine and, in addition, by using our method. The scoliosis Cobb angles ranged from 11 - 59 degrees (mean: 23 degrees +/- 9 degrees ), the real angles ranged from 12 - 70 degrees (mean: 32 +/- 14 degrees ). There was a poor correlation between Cobb angles and the 3D calculated angles (r = 0.37; p < 0.0001)., Conclusion: Our method enables us to determine the real angle of scoliosis and to avoid techniques with any radiation risk for the patient.

Aim: A newly developed MR procedure allows imaging of the whole spine in coronal and sagittal planes. We studied the use of total spine MR imaging in measuring sagittal Cobb angles in scoliosis., Method: 64 patents with idiopathic scoliosis (mean age 18.1 years, 35 thoracic, 20 double major, and 9 lumbar curves) and 27 patients without scoliosis were consecutively examined. The MR images were acquired in the supine position. The sagittal Cobb angles were measured between T4-T12 and between T12-L5., Results: For the group of the thoracic and double major scoliosis the mean sagittal Cobb angle (T4-T12) was 13 degrees and for the group without scoliosis 23 degrees, which was a significant difference (p < 0.01, Mann Whitney-U-test). There was a negative correlation between the sagittal Cobb angles (T4-T12) and the lateral, thoracic curves. The mean sagittal Cobb angle (T12-L5) of the group with lumbar and double major curves was 35 degrees, which was not a significant difference when compared to 37 degrees of the non-scoliotic group., Conclusion: Using total spine MR imaging the lordotic aspect of the thoracic deformation in scoliosis can be reliably measured. Because of the absent radiation exposure the sagittal MR reconstructions could be used as an additional imaging in monitoring scoliosis.