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Background: Chondroblastoma is a rare, benign bone tumor originating from immature chondrocytes, typically found in the epiphyseal plates of long bones. Its occurrence in the skull, particularly the occipital bone, is extremely rare. Case presentation: We report a 10-year-old girl presenting with paroxysmal dizziness, occipital pain, and a palpable mass. Imaging studies revealed an osteolytic lesion in the occipital bone with a multiloculated appearance, indicating a concomitant aneurysmal bone cyst. The patient underwent craniotomy with complete tumor excision. Postoperative follow-up showed no neurological deficits or complications and MRI confirmed no recurrence. Conclusion: This case highlights the rare presentation of occipital bone chondroblastoma and emphasizes the importance of early surgical intervention for positive outcomes in pediatric patients. [ABSTRACT FROM AUTHOR]

Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the correlations of CVT with age and sex and develop a regression model for age estimation in Malaysian subadults using computed tomography (CT) images. A total of 521 CT images (male/female: 279/242; age range: 0–20 years; Malay/Chinese/Indian: 221/145/155) were included in the study. Correlations of CVT measurements with age and sex, including frontal bone thickness (FBT), occipital bone thickness (OBT), left parietal bone thickness (LPBT), and right parietal bone thickness (RPBT) were assessed and regression formulae were developed for age estimation in subadults. A significant correlation between CVT measurements and age was demonstrated (p < 0.001). Age estimation was most accurate in the younger age group (< 2 years) at frontal and occipital, and accuracy decreases in the older age groups. Additionally, sexual dimorphism was evident in the frontal and parietal bone thickness within the age range of 3–6 years and 16–20 years, respectively. In conclusion, the findings suggested CVT measurements could be used to corroborate other age estimation methods for subadults. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of an anomalous posterosuperior course of the V3 segment of the right vertebral artery (VA) that penetrated the occipital bone (wall of the jugular foramen). Methods: A 33-year-old healthy woman underwent cranial magnetic resonance (MR) imaging and MR angiography from the upper cervical to the intracranial region using a 3-Tesla scanner to screen for asymptomatic brain lesions, including cerebrovascular diseases. Results: MR angiography showed no pathological arterial lesions such as aneurysms; however, there was an anomalous posterosuperior course of the V3 segment of the right VA. On MR angiographic source images and coronal reformatted images, the right VA was observed to penetrate the occipital bone lateral to the right hypoglossal canal and is located on the inferoposteromedial wall of the right jugular foramen and enter the posterior fossa at a higher level than the foramen magnum. Conclusion: We present a case in which the right VA showed an anomalous posterosuperior course at the craniovertebral junction. It is extremely rare for a VA to take a higher course. To our knowledge, this is the first report of such a VA variation in the relevant English-language literature. We speculated that the right VA of our patient was formed by the persistence of one more cephalad primitive artery than the first intersegmental artery, not by the persistence of the primitive hypoglossal artery. Careful observation of MR angiographic source is useful and important for identifying the VA penetrating the occipital bone. [ABSTRACT FROM AUTHOR]

Purpose: The topic of osseous variations of the craniocervical junction is a complex morphological and embryological chapter of human anatomy, with a possible impact on neurogical and vascular functionality in this morphological variable region. Material & methods: An until now undescribed anatomical variation of the exoccipital part of the occipital bone has been observed after maceration at the outer skull base of a West-European 68-year-old male body donor. Results: On both sites of the foramen magnum accessory osseous processes were observed that arise from the jugular process and point towards the lateral margin of the foramen magnum. On the left site this process forms a full arc that bridges the condylar fossa completely. Conclusion: The observed osseous bridge over the condylar fossa has not been reported on before and can be explained by the partial persistence of a primordial vertebra between atlas and occipital bone: the Proatlas. The resulting accessory structure may affect due to its topographic conditions the V3-Segment of the vertebral artery and its accompanying nerves, and thus, play a role in diagnosis and therapy of vascular and/or neurological symptoms of head and neck. [ABSTRACT FROM AUTHOR]

Post-mortem computed tomography (PMCT) enables the creation of subject-specific 3D head models suitable for quantitative analysis such as finite element analysis (FEA). FEA of proposed traumatic events is an objective and repeatable numerical method for assessing whether an event could cause a skull fracture such as seen at autopsy. FEA of blunt force skull fracture in adults with subject-specific 3D models in forensic pathology remains uninvestigated. This study aimed to assess the feasibility of FEA for skull fracture analysis in routine forensic pathology. Five cases with blunt force skull fracture and sufficient information on the kinematics of the traumatic event to enable numerical reconstruction were chosen. Subject-specific finite element (FE) head models were constructed by mesh morphing based on PMCT 3D models and A Detailed and Personalizable Head Model with Axons for Injury Prediction (ADAPT) FE model. Morphing was successful in maintaining subject-specific 3D geometry and quality of the FE mesh in all cases. In three cases, the simulated fracture patterns were comparable in location and pattern to the fractures seen at autopsy/PMCT. In one case, the simulated fracture was in the parietal bone whereas the fracture seen at autopsy/PMCT was in the occipital bone. In another case, the simulated fracture was a spider-web fracture in the frontal bone, whereas a much smaller fracture was seen at autopsy/PMCT; however, the fracture in the early time steps of the simulation was comparable to autopsy/PMCT. FEA might be feasible in forensic pathology in cases with a single blunt force impact and well-described event circumstances. [ABSTRACT FROM AUTHOR]

Purpose: To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. Methods: This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. Results: Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. Conclusions: In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction. [ABSTRACT FROM AUTHOR]

Autosomal dominantly inherited neurofibromatosis type I (NF1) is a systemic disorder caused by a mutation of a gene on chromosome 17q11.2 and characterized by multiple café-au-lait spots, lentiginous macules, Lisch nodules of the iris, and tumors of the nervous system. Bony manifestations such as scoliosis, dysplasia of the greater sphenoidal wing, tibial pseudoarthrosis, short stature, and macrocephaly have been reported in approximately 50% of patients. However, calvarial bone defects are rare. After screening 324 articles, 23 cases (12 adult and 11 pediatric patients) of occipital bone defects in NF1 patients were selected. All patients had a single/multiple bone defect over the lambdoid suture. Adjacent benign plexiform neurofibromas were observed in 14 patients (60.8%, 7 adults and 7 children); one adult patient was diagnosed with neurofibrosarcoma. Meningoencephalocele over the occipital defect was noted in 8 cases (34.78%, all adults). Cranioplasty was performed in only 17.39% of patients. Histologic examination was performed in 7 of the 15 patients with associated neurofibromas/neurofibrosarcomas. Biopsy of the bone margins surrounding the defect was performed in only one case. Pathologic examination of the herniated parieto-occipital or cerebellar tissue was not performed in any of the patients studied. We report the case of a 9-year-old girl with NF1 and a significant occipital bone defect and performed a systematic review of the relevant literature to highlight the challenges in treating this condition and to investigate the underlying mechanisms contributing to bone defects or dysplasia in NF1. [ABSTRACT FROM AUTHOR]

Background: Rectus capitis lateralis muscle (RCLM) is located at the border between the ventral and dorsal muscle groups, but the nerve topographical anatomy around the muscle is obscure. Materials and methods: We observed the RCLM in histological sections of 12 midterm and 10 near-term fetal heads (9–18 and 26–40 weeks of gestational age). Results: At midterm, the RCLM wrapped around the inferiorly protruding inferolateral corner of the cartilaginous occipital bone. The muscle was adjacent to, or even continued to, the intertransversarius muscle between the atlas and axis. At near-term, the jugular process of the occipital bone, that is, the RCLM upper insertion, was either cartilaginous or bony, depending on age. The process formed a collar supporting the internal jugular vein from the inferior side. Moreover, the muscle is tightly attached to or inserted into the venous wall itself. The cartilaginous jugular process was adjacent to Reichert's cartilage, and the uppermost muscle fibers passed through a narrow space between these cartilages. The RCLM appeared to accelerate the jugular process elongation, resulting in complete union of the occipital and temporal bones. The ventral ramus of the first cervical nerve passed between the RCLM and rectus capitis anterior muscle to reach the longus capitis muscle. No nerve passed between the RCLM and the obliquus capitis superior muscle (a muscle at the suboccipital triangle). Conclusion: The dorsoventral position of the RCLM seemed to correspond to the scalenus posterior muscle in a laminar arrangement of the cervical axial musculature. [ABSTRACT FROM AUTHOR]

Purpose: Sheep are used as a large-animal model for otology research and can be used to study implantable hearing devices. However, a method for temporal bone extraction in sheep, which enables various experiments, has not been described, and literature on middle ear access is limited. We describe a method for temporal bone extraction and an extended facial recess surgical approach to the middle ear in sheep. Methods: Ten temporal bones from five Hampshire sheep head cadavers were extracted using an oscillating saw. After craniotomy and removal of the brain, a coronal cut was made at the posterior aspect of the orbit followed by a midsagittal cut of the occipital bone and disarticulation of the atlanto-occipital joint. Temporal bones were surgically prepared with an extended facial recess approach. Micro-CT scans of each temporal bone were obtained, and anatomic dimensions were measured. Results: Temporal bone extraction was successful in 10/10 temporal bones. Extended facial recess approach exposed the malleus, incus, stapes, and round window while preserving the facial nerve, with the following surgical considerations: minimally pneumatized mastoid; tegmen (superior limit of mastoid cavity) is low-lying and sits below temporal artery; chorda tympani sacrificed to optimize middle ear exposure; incus buttress does not obscure view of middle ear. Distance between the superior aspect of external auditory canal and tegmen was 2.7 (SD 0.9) mm. Conclusion: We identified anatomic landmarks for temporal bone extraction and describe an extended facial recess approach in sheep that exposes the ossicles and round window. This approach is feasible for studying implantable hearing devices. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study aimed to investigate the association between the occipital spur length and craniofacial morphology in individuals with occipital spur (OS). Methods: The study included cephalometric images from 451 individuals (196 females, 255 males, age range was 9–84 years). The spur length and craniofacial characteristics were evaluated using cephalograms. Based on spur length, subjects were divided into two groups: the OS group (N = 209) and the enlarged occipital spur (EOS) group (N = 242). Descriptive statistics, Independent T-test, Mann–Whitney U test, chi-square test, Kruskal–Wallis test, and age- and sex-based stratified analyses were performed. The level of significance was set at p < 0.05. Results: Males had significantly larger spur length than females. Spur length was shorter in individuals under 18 than the groups over 18. After adjusting for gender and age, ramus height, mandibular body length, effective length of maxilla, effective length of mandible, anterior cranial base length, posterior cranial base length, anterior facial height, posterior facial height, facial height index, and lower anterior facial height had statistically significant differences between OS group and EOS group. Conclusions: Males exhibit greater spur length than females. Patients under 18 had a shorter spur length than adults. Linear craniofacial measurements were found to be greater in subjects with EOS than the individuals with OS. The craniofacial growth and development of an individual might be associated with EOS. The causal relationship between EOS and craniofacial development requires further longitudinal studies. [ABSTRACT FROM AUTHOR]

Down syndrome, also known as trisomy 21, is associated with congenital cervical spine abnormalities, including atlantoaxial instability with or without os odontoideum, atlanto-occipital instability, and hypoplasia of the atlas. Herein, we report a case of Down syndrome complicated by congenital atlanto-occipital dislocation. The patient presented with severe cervical myelopathy at 13 years of age after a 10-year follow-up. Radiography and computed tomography revealed os odontoideum protruding into the foramen magnum and congenital anterior atlanto-occipital dislocation. Additionally, a bifurcated internal occipital crest with a thinned central portion of the occipital bone was noted. Magnetic resonance imaging revealed kyphotic alignment of the spinal cord with severe compression at the foramen magnum level. As the neurological impairment was partially improved by halo vest immobilization, we performed in situ O-C2 fusion with an iliac autograft and decompression of the foramen magnum and posterior arch of C1. An improvement was observed immediately after surgery. Two years after surgery, radiography and computed tomography showed solid O-C2 segment fusion. The accumulation of similar cases is essential for determining the prognosis or optimal treatment for this rare congenital condition. [ABSTRACT FROM AUTHOR]

Introduction: Tumor-induced osteomalacia (TIO) is an uncommon paraneoplastic syndrome due to the overproduction of fibroblast growth factor 23 (FGF23). It is predominantly caused by mesenchymal tumors and cured upon their complete removal. Non-surgical treatment is an alternative option but limited to specific clinical conditions. Methods: We report a challenging case of TIO caused by a tumor involving the occipital bone. We also performed a literature review of TIO caused by tumors localized at this site, focusing on clinical findings, treatment, and outcomes. Results: The patient, a 62-year-old male, presented with a long-lasting history of progressive weakness. Biochemical evaluation revealed severe hypophosphatemia due to low renal tubular reabsorption of phosphate with raised intact FGF23 values. A 68 Ga-DOTATATE PET/TC imaging showed a suspicious lesion located in the left occipital bone that MRI and selective venous catheterization confirmed to be the cause of TIO. Stereotactic gamma knife radiosurgery was carried out, but unfortunately, the patient died of acute respiratory failure. To date, only seven additional cases of TIO have been associated to tumors located in the occipital bone. Furthermore, the tumor involved the left side of the occipital bone in all these patients. Conclusion: The occipital region is a difficult area to access so a multidisciplinary approach for their treatment is required. If anatomical differences could be the basis for the predilection of the left side of the occipital bone, it remains to be clarified. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate that occipital artery (OA)-p1 posterior inferior cerebellar artery (PICA) bypass can be an alternative for complex posterior circulation aneurysms. Methods: A far-lateral approach to craniotomy was performed on 20 cadaveric specimens, and the OA was obtained 'in-line.' Its length, diameter, and the number of p1/p2 and p3 segmental perforators were determined, and the relationship between the caudal loop and cerebellar tonsil position was also assessed. The distance between the PICA's origin and the cranial nerve XI (CN XI), the buffer length above the CN XI after dissection, the OA length required to complete the OA-p1/p3 PICA bypass, and the p1 and p3 segment diameters were all measured. A bypass training practical scale (TSIO) was used to evaluate the quality of the anastomosis. Results: All specimens underwent OA-p1 PICA end-to-end bypass and had favorable results for the TSIO score, 15 sides underwent OA-p3 PICA end-to-side bypass, and the other bypass protocols were less common. The buffer length above the CN XI after dissection, the distance between the PICA's origin and the CN XI, and the first perforator were all of sufficient length. The direct length of the OA needed to complete the OA-p1 PICA end-to-end bypass was significantly less than the available length and the OA-p3 PICA end-to-side bypass, with the OA matching the p1 segment diameter. The number of p1 perforators was less than that of p3, and the OA diameter was equal to that of the p1 segment. Conclusion: OA-p1 PICA end-to-end bypass is a feasible alternative in cases in which p3 segment has high caudal loops or anatomic anomalies. [ABSTRACT FROM AUTHOR]

Background and purpose: The purpose of this study was to identify and classify the different types of anterior atlanto-occipital membrane complex injuries on MRI and evaluate for the presence, size, and location of a prevertebral effusion on the preceding CT exams. Materials and methods: Patients who suffered an anterior atlanto-occipital membrane complex injury were identified retrospectively utilizing Nuance mPower software. An anatomic-based description of the location of the anterior atlanto-occipital membrane complex injury was recorded along with any additional osteoligamentous trauma of the craniocervical junction. The preceding cervical CT exams for these patients were reviewed for the presence and location of a prevertebral effusion. Results: Fifty patients were identified with an acute, post-traumatic anterior atlanto-occipital membrane complex injury. Three distinct patterns of anterior atlanto-occipital membrane complex injury were observed. Nineteen patients demonstrated increased STIR signal with disruption of the anterior atlanto-occipital membrane, ten patients demonstrated increased STIR signal with disruption of the anterior atlanto-axial membrane, and twenty-one patients demonstrated increased STIR signal with disruption of both the anterior atlanto-occipital membrane and anterior atlanto-axial membrane. An effusion at the C1-C2 level was present in greater than 90% of patients with anterior atlanto-occipital membrane complex injury. Conclusions: The presence of a craniocervical prevertebral effusion on CT in trauma patients may raise suspicion for an injury to the anterior atlanto-occipital membrane complex and potentially trigger additional investigation with cervical MRI. [ABSTRACT FROM AUTHOR]

1. To study the various clinical presentations, microbiological and radiological profiles in patients of skull base osteomyelitis, to know about the underlying comorbidities or immunocompromised status and its relation to the disease and its management. 2. To study the effect of long term intravenous antimicrobial therapy with respect to clinical outcomes and radiological improvement and to study the long term outcomes of the treatment. This is an observational prospective and retrospective study. Thirty adult patients who were diagnosed with skull base osteomyelitis by clinical/microbiological and or radiological features were treated with long term intravenous antibiotics according to pus culture and s for 6–8 weeks and they were followed up for 6 months. Clinical improvement in symptoms and signs, radiological imaging features and pain score were assessed after 3 and 6 months. We noticed in our study that skull base osteomyelitis are more common in older patients with male predominance. Presenting symptoms include ear discharge, otalgia, hearing, cranial nerve palsy. Immunocompromised state, mainly Diabetes mellitus is closely associated with skull base osteomyelitis. Majority of patients showed Pseudomonas related species on pus culture and sensitivity. All the patients showed temporal bone involvement in CT and MRI. Other bones involved were shenoid, clivus and occipital bone. Majority showed good clinical response to intravenous ceftazidime, combination of piperacillin and tazobactum, followed by combination of piptaz and Ciprofloxacin. Treatment duration was 6–8 weeks. All patients showed clinical improvement in symptoms and relief in pain after 3 and 6 months. Skull base osteomyelitis is a rare condition, most commonly seen in elderly patients with diabetes mellitus and or other immunocompromised condition. Pseudomonas related species are the major causes of skull base osteomyelitis. Long term pus culture and sensitivity bases intravenous antibiotic therapy is the main stay of treatment. [ABSTRACT FROM AUTHOR]

Keywords: CSF filled bone cysts; Foramen magnum decompression; Intradiploic CSF EN CSF filled bone cysts Foramen magnum decompression Intradiploic CSF 351 354 4 02/14/23 20230201 NES 230201 This article is part of the Topical Collection on CSF Circulation Primary bone cysts are uncommon in the spine. Conclusion CSF-filled C2 bone cyst after foramen magnum decompression is uncommon, and this is the first report describing its surgical management which preserves motion and helps to fix pathological bone fractures without metalwork. Foramen magnum decompression, Intradiploic CSF, CSF filled bone cysts. [Extracted from the article]

Purpose: Acquired Chiari I malformation is an uncommon but possible late complication of supratentorial shunting in children. This condition can be caused by an abnormal thickening of the cranial vault and consequent reduction of the posterior cranial fossa (PCF) volume especially in children with already a small PCF volume. The management of Acquired Chiari I malformation is very challenging, and several options have been proposed for this condition. These are aimed to expand the PCF volume both through decompression and PCF remodeling in order to relieve symptoms of acquired Chiari I malformation. A cranial vault remodeling or a standard Chiari decompression is two proposed techniques aimed to expand the PCF volume thus relieving symptoms. Methods: We describe the case of a 16-year-old girl undergone surgical removal of sellar-suprasellar glioneuronal tumor and ventriculo-peritoneal shunting, who developed an acquired symptomatic Chiari type I malformation some years after ventricular-peritoneal shunting. For this condition, she underwent successful standard Chiari decompression with C0–C1 craniectomy and duroplasty. Results: We retrospectively analyzed MRI and CT scan performed during follow-up, in order to evaluate the volume of the posterior cranial fossa and to measure the variation of skull thickness at different periods. MRI and CT scan analysis showed a progressive thickening of the calvaria, in particular of the occipital bone, leading to a progressive reduction of PCF volume with the establishment of acquired Chiari type I malformation. In this case, standard C0–C1 Chiari decompression was effective in restoring PCF volume and relieving symptoms. Conclusion: Acquired Chiari I malformation due to chronic overhunting could be a severe and late complication in patient undergone supratentorial shunting. These patients require careful clinical and radiological follow-up to avoid over-drainage. According to our analysis, a careful selection of pediatric patients for supratentorial shunting should be made according to pre-operative PCF volume in order to foresee higher odds of possible late complications from over-drainage. [ABSTRACT FROM AUTHOR]

The accurate interpretation of a blunt force head injury relies on an understanding of the case circumstances (extrinsic variables) and anatomical details of the individual (intrinsic variables). Whilst it is often possible to account for many of these variables, the intrinsic variable of neurocranial thickness is difficult to account for as data for what constitutes 'normal' thickness is limited. The aim of this study was to investigate the effects of age, sex and ancestry on neurocranial thickness, and develop reference ranges for average neurocranial thickness in the context of those biological variables. Thickness (mm) was measured at 20 points across the frontal, left and right parietals, left and right temporals and occipital bones. Measurements were taken from post-mortem computed tomography scans of 604 individuals. Inferential statistics assessed how age, sex and ancestry affected thickness and descriptive statistics established thickness means. Mean thickness ranged from 2.11 mm (temporal squama) to 19.19 mm (petrous portion). Significant differences were noted in thickness of the frontal and temporal bones when age was considered, all bones when sex was considered and the, right parietal, left and right temporal and occipital bones when ancestry was considered. Furthermore, significant interactions in thickness were seen between age and sex in the frontal bone, ancestry and age in the temporal bone, ancestry and sex in the temporal bone, and age, sex and ancestry in the occipital bone. Given the assorted influence of the biological variables, reference measurement ranges for average thickness incorporated these variables. Such reference measurements allow forensic practitioners to identify when a neurocranial bone is of normal, or abnormal, thickness. [ABSTRACT FROM AUTHOR]

Lambdoid craniosynostosis (CS) is a congenital anomaly resulting from premature fusion of the cranial suture between the parietal and occipital bones. Predominantly sporadic, it is the rarest form of CS and its genetic etiology is largely unexplored. Exome sequencing of 25 kindreds, including 18 parent–offspring trios with sporadic lambdoid CS, revealed a marked excess of damaging (predominantly missense) de novo mutations that account for ~ 40% of sporadic cases. These mutations clustered in the BMP signaling cascade (P = 1.6 × 10–7), including mutations in genes encoding BMP receptors (ACVRL1 and ACVR2A), transcription factors (SOX11, FOXO1) and a transcriptional co-repressor (IFRD1), none of which have been implicated in other forms of CS. These missense mutations are at residues critical for substrate or target sequence recognition and many are inferred to cause genetic gain-of-function. Additionally, mutations in transcription factor NFIX were implicated in syndromic craniosynostosis affecting diverse sutures. Single cell RNA sequencing analysis of the mouse lambdoid suture identified enrichment of mutations in osteoblast precursors (P = 1.6 × 10−6), implicating perturbations in the balance between proliferation and differentiation of osteoprogenitor cells in lambdoid CS. The results contribute to the growing knowledge of the genetics of CS, have implications for genetic counseling, and further elucidate the molecular etiology of premature suture fusion. [ABSTRACT FROM AUTHOR]

Remembering unpleasant events can trigger negative feelings. Fortunately, research indicates that unwanted retrieval can be suppressed to prevent memories from intruding into awareness, improving our mental state. The current scientific understanding of retrieval suppression, however, is based mostly on simpler memories, such as associations between words or pictures, which may not reflect how people control unpleasant memory intrusions in everyday life. Here, we investigated the neural and behavioural dynamics of suppressing personal and emotional autobiographical memories using a modified version of the Think/No-Think task. We asked participants to suppress memories of their own past immoral actions, which were hypothesised to be both highly intrusive and motivating to suppress. We report novel evidence from behavioural, ERP, and EEG oscillation measures that autobiographical memory retrieval can be suppressed and suggest that autobiographical suppression recruits similar neurocognitive mechanisms as suppression of simple laboratory associations. Suppression did fail sometimes, and EEG oscillations indicated that such memory intrusions occurred from lapses in sustained control. Importantly, however, participants improved at limiting intrusions with repeated practice. Furthermore, both behavioural and EEG evidence indicated that intentional suppression may be more difficult for memories of our morally wrong actions than memories of our morally right actions. The findings elucidate the neurocognitive correlates of autobiographical retrieval suppression and have implications for theories of morally motivated memory control. [ABSTRACT FROM AUTHOR]

Error detection and error significance form essential mechanisms that influence error processing and action adaptation. Error detection often is assessed by an immediate self-evaluation of accuracy. Our study used cognitive neuroscience methods to elucidate whether self-evaluation itself influences error processing by increasing error significance in the context of a complex response selection process. In a novel eight-alternative response task, our participants responded to eight symbol stimuli with eight different response keys and a specific stimulus-response assignment. In the first part of the experiment, the participants merely performed the task. In the second part, they also evaluated their response accuracy on each trial. We replicated variations in early and later stages of error processing and action adaptation as a function of error detection. The additional self-evaluation enhanced error processing on later stages, probably reflecting error evidence accumulation, whereas earlier error monitoring processes were not amplified. Implementing multivariate pattern analysis revealed that self-evaluation influenced brain activity patterns preceding and following the response onset, independent of response accuracy. The classifier successfully differentiated between responses from the self- and the no-self-evaluation condition several hundred milliseconds before response onset. Subsequent exploratory analyses indicated that both self-evaluation and the time on task contributed to these differences in brain activity patterns. This suggests that in addition to its effect on error processing, self-evaluation in a complex choice task seems to have an influence on early and general processing mechanisms (e.g., the quality of attention and stimulus encoding), which is amplified by the time on task. [ABSTRACT FROM AUTHOR]

Connectivity of the brain at rest can reflect individual differences and impact behavioral outcomes, including memory. The present study investigated how culture influences functional connectivity with regions of the medial temporal lobe. In this study, 46 Americans and 59 East Asians completed a resting state scan after encoding pictures of objects. To investigate cross-cultural differences in resting state functional connectivity, left parahippocampal gyrus (anterior and posterior regions) and left hippocampus were selected as seed regions. These regions were selected, because they were previously implicated in a study of cultural differences during the successful encoding of detailed memories. Results revealed that left posterior parahippocampal gyrus had stronger connectivity with temporo-occipital regions for East Asians compared with Americans and stronger connectivity with parieto-occipital regions for Americans compared with East Asians. Left anterior parahippocampal gyrus had stronger connectivity with temporal regions for East Asians than Americans and stronger connectivity with frontal regions for Americans than East Asians. Although connectivity did not relate to memory performance, patterns did relate to cultural values. The degree of independent self-construal and subjective value of tradition were associated with functional connectivity involving left anterior parahippocampal gyrus. Findings are discussed in terms of potential cultural differences in memory consolidation or more general trait or state-based processes, such as holistic versus analytic processing. [ABSTRACT FROM AUTHOR]

Sex identification is a primary step in forensic analysis of skeletal remains. The accuracy of sex estimation methods greatly depends on the sexual dimorphism manifested by the target anatomical region. The study aims to evaluate the sexual dimorphism in shape and size of the neurocranium and to compare the potential of shape and size of different cranial regions to classify correctly the male and female crania. The study was carried out on computed tomography images of 373 Bulgarian adults (161 males and 212 females). Three-dimensional coordinates of 32 landmarks were acquired. The landmarks were arranged in 4 configurations: neurocranium, frontal bone, parietotemporal region, and occipital bone. For each configuration, the presence of significant sex differences in shape and size was tested. Principal component analysis (PCA) was applied to explore the shape variation. The classification power of size and shape was tested using discriminant analysis and k-means clustering. The neurocranium shows significant sex differences in shape and size. The parietotemporal region is the most dimorphic neurocranial part in size and the frontal bone is the most differing one in shape. The size of the parietotemporal region and frontal bone classifies correctly more than 80% of the crania. The discrimination ability based on shape is rather low as the highest values of about 70% are obtained for the frontal and occipital bone. The PCA plots show large overlapping of the male and female crania. It can be inferred that the sex-specific size differences in the neurocranium are more important than the shape differences. [ABSTRACT FROM AUTHOR]

Purpose: The foramen magnum (FM) presents various alterations in craniosynostoses, such as brachycephaly or Crouzon syndrome. However, to date, no study has been devoted to its morphology and morphometry in scaphocephaly, which is the most common of cranial deformities resulting from premature fusion of cranial sutures. Methods: We assessed the morphology and morphometry of FM using preoperative thin-cut CT scans of 107 children with non-syndromic sagittal craniosynostosis aged 1–12 months (mean age 5.38 months). A series of sagittal and transverse dimensions were taken and the FM area was calculated in each case. Obtained data were compared to the age-matched control group of 101 normocephalic children. Results: Dolichotrematous type of FM was dominant in the scaphocephaly group and observed in 63/107 cases (58.9%). The mean FM area in the scaphocephaly group was 519.64 mm2 and was significantly smaller compared to the control group (p = 0.0011). The transverse diameter and anterior sagittal diameter were also significantly smaller (p = 0.0112 and p = 0.0003, respectively). Conclusion: The area of FM in scaphocephaly is smaller compared to normal individuals. This is associated with a significant reduction of the width of FM in children with sagittal craniosynostosis. FM in scaphocephaly is larger than in other reported series of children with brachycephaly or Crouzon syndrome. [ABSTRACT FROM AUTHOR]

Bow Hunter's syndrome is a rare cause of posterior circulation ischemia, produced by the mechanical and reversible occlusion of the vertebral artery during cephalic rotation. Diagnosis requires clinical suspicion and careful inspection of images with three-dimensional reconstruction. The study of choice is dynamic digital subtraction angiography (DSA). Treatment alternatives are: medical, surgical or endovascular. We report the case of an 8-year-old boy with recurrent infarctions of the posterior circulation secondary to the dissection of the vertebral artery, in association with an occipital bone spur. Dynamic DSA was negative. Conservative initial management was elected with cervical immobilization and anticoagulation, but due to persistence of symptoms, surgical decompression was decided. The patient did not repeat symptoms postoperatively and returned to his usual life. This is the first case reported to our knowledge of a surgical pediatric patient with asymptomatic atypical compression of VA secondary to BHS, whose dynamic angiography was negative, suggesting an alternative mechanism of the syndrome. [ABSTRACT FROM AUTHOR]

1Gabriele Falloppio, an Italian priest, anatomist, and physician His father, Geronimo Falloppio, died of syphilis when Gabriele Falloppio was only 10 years old. Gabriele Falloppio, one of the most precious anatomists of the sixteenth century, was born in 1523 in Modena, Italy, with the better-known Latin name " I Fallopius i " (Fig. 23445127 5 Tsaraklis A, Karamanou M, Androutsos G. Preventing syphilis in the 16th century: the distinguished Italian anatomist Gabriele Falloppio (1523-1562) and the invention of the condom. [Extracted from the article]

Amyotrophic lateral sclerosis (ALS) is associated with considerable clinical heterogeneity spanning from diverse disability profiles, differences in UMN/LMN involvement, divergent progression rates, to variability in frontotemporal dysfunction. A multitude of classification frameworks and staging systems have been proposed based on clinical and neuropsychological characteristics, but disease subtypes are seldom defined based on anatomical patterns of disease burden without a prior clinical stratification. A prospective research study was conducted with a uniform imaging protocol to ascertain disease subtypes based on preferential cerebral involvement. Fifteen brain regions were systematically evaluated in each participant based on a comprehensive panel of cortical, subcortical and white matter integrity metrics. Using min–max scaled composite regional integrity scores, a two-step cluster analysis was conducted. Two radiological clusters were identified; 35.5% of patients belonging to 'Cluster 1' and 64.5% of patients segregating to 'Cluster 2'. Subjects in Cluster 1 exhibited marked frontotemporal change. Predictor ranking revealed the following hierarchy of anatomical regions in decreasing importance: superior lateral temporal, inferior frontal, superior frontal, parietal, limbic, mesial inferior temporal, peri-Sylvian, subcortical, long association fibres, commissural, occipital, 'sensory', 'motor', cerebellum, and brainstem. While the majority of imaging studies first stratify patients based on clinical criteria or genetic profiles to describe phenotype- and genotype-associated imaging signatures, a data-driven approach may identify distinct disease subtypes without a priori patient categorisation. Our study illustrates that large radiology datasets may be potentially utilised to uncover disease subtypes associated with unique genetic, clinical or prognostic profiles. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the presence of occipital spurs, morphologic/morphometric features, and the presence of ossification of ligamentum nuchae (ONL) on lateral cephalometric radiographs of individuals aged under and over 18 years. Methods: Lateral cephalometric radiographs of 1430 individuals aged between 14–50 years were scanned. The presence of ONL and occipital spurs was evaluated in 1312 patients who met the inclusion criteria, and existing occipital spurs were measured and their types (flat/crest/spine) were recorded. Results: Occipital spurs were detected in 63 patients aged over 18 years (63/120; 52.5%) and 57 patients aged under 18 years (57/120; 47.5%). When the spur length by age category and sex was evaluated, no statistically significant difference was observed. The spur types seen were flat (40.8%; 49/120), crest (30%; 36/120) and spine (29.2%; 35/120), respectively. Although there was no statistically significant difference between the spur types seen in terms of age, a significant difference was observed between the sexes in the total group (p < 0.001). Spine-type spurs (66.7%; 18/27) were the most common in females, and flat-type spurs (45.2%; 42/39) were the most common in males. ONL was detected in only three individuals. Conclusion: No relationship was found between the presence of occipital spurs and ONL. Although spur length was not affected by age and sex, spur types were found to vary according to sex. Occipital spurs are mostly asymptomatic and detected incidentally on lateral cephalometric radiographs. They are one of the important anatomic formations that should be diagnosed by physicians. [ABSTRACT FROM AUTHOR]

The eye orbit has mechanical and acoustic characteristics that determine resonant frequencies and amplify acoustic signals in certain frequency ranges. These characteristics also interfere with the acoustic amplitudes and frequencies of eyeball when measured with an acoustic tonometer. A model in which a porcine eyeball was embedded in ultrasonic conductive gel in the orbit of a model skull was used to simulate an in vivo environment, and the acoustic responses of eyeballs were detected. The triggering source was a low-power acoustic speaker contacting the occipital bone, and the detector was a high-resolution microphone with a dish detecting the acoustic signals without contacting the cornea. Dozens of ex vivo porcine eyeballs were tested at various intraocular pressure levels to detect their resonant frequencies and acoustic amplitudes in their power spectra. We confirmed that the eyeballs' resonant frequencies were proportional to intraocular pressure, but interference from orbit effects decreased the amplitudes in these resonant frequency ranges. However, we observed that the frequency amplitudes of eyeballs were correlated with intraocular pressure in other frequency ranges. We investigated eye orbit effects and demonstrated how they interfere with the eyeball's resonant frequencies and frequency amplitudes. These results are useful for developing advanced acoustic tonometer. [ABSTRACT FROM AUTHOR]

Summary: Craniocervical abnormalities in osteogenesis imperfecta (OI) such as basilar invagination or cervical kyphosis can cause severe neurological morbidity. These abnormalities may be more frequent in OI type V compared with other OI subtypes of similar disease severity, underlining the importance of screening in this group. Introduction: Craniocervical abnormalities in osteogenesis imperfecta (OI) can cause severe neurological morbidity. Although radiological cranial base abnormalities in OI have been well described in the literature, there are limited data on these abnormalities in OI type V and their association with clinical sequelae. Methods: A retrospective case series on patients with craniocervical abnormalities in OI type V at our institution. Results: Craniocervical abnormalities were present in 7 of 37 patients with OI type V (19%). For 5 patients (age at last follow-up: 5 to 26 years; 2 females), sufficient information was available for inclusion in the case series. All had genetically confirmed OI type V. Age range at diagnosis of the craniocervical abnormality was 1 day to 18 years. Basilar invagination was present in 3 patients; 2 had cervical kyphosis. Dysplasia of upper cervical vertebrae or base of skull was seen in 3 patients. The severity of the craniocervical abnormality did not clearly correlate with the severity of the OI phenotype. Three patients required surgical intervention (ages 7, 11, and 26 years) due to compression of the spinal cord or brainstem. Craniocervical abnormalities were detected incidentally or on screening in 3 patients, and only 2 had significant positive findings on neurological examination. Conclusion: A variety of craniocervical abnormalities are seen in OI type V including dysplasia of the cervical vertebrae. These cases highlight the importance of screening patients with OI type V with lateral skull and cervical spine x-rays throughout childhood and after skeletal maturity. [ABSTRACT FROM AUTHOR]

Background: An encephalocele is a congenital neural tube defect characterized by herniation of cranial contents through a defect in the cranium and is caused by failure of the closure of the cranial part of the developing neural tube. An encephalocele is termed as "giant encephalocele" when the size of encephalocele is larger than the size of the head. They depend on size of the sac, percentage of neural tissue content, hydrocephalus, infection, and other associated pathologies for a favorable neurological outcome. Case presentation: We report a case of a four-month-old boy with a giant occipital encephalocele measuring 21 × 15 × 19 cm in size, which was a surgical and anesthetic challenge for us. Intubation was achieved in lateral position. Part of occipital and cerebellar parenchyma was present in the sac and bony defect was approximately 2.5 cm in occipital bone in midline. We performed surgical excision and repair with a good overall outcome. Conclusion: Perioperative management of a giant occipital encephalocele is a challenge for both anesthesiologists and neurosurgeons. Managing such a case demands a search for other congenital abnormalities, expertise in handling airway, and proper intraoperative care. Careful planning and perioperative management are essential for a successful outcome. [ABSTRACT FROM AUTHOR]

Background: Different techniques to reshape the posterior skull vault have been developed in the last decades, all sharing the same goals of increasing the skull volume, decreasing the intracranial pressure (ICP), correcting the cranial dysmorphy, and contributing to a better growth of the skull. Though over the last years most refinements in these techniques have focused on the use of hardware as distractors or springs, the fixed posterior vault expansion remains a valuable procedure for cranial remodeling. Methods: We describe in details the technique used for fixed posterior vault expansion in children that is applied at the French Referral center for Craniosynostosis of Lyon, France. Discussion: The fixed posterior vault expansion increases the risk of perioperative complications due to the elevation of the posterior bone flap from the dura but allows an immediate decompression and correction of the shape, simplifying the postoperative course. [ABSTRACT FROM AUTHOR]

The myodural bridge (MDB) is a dense connective tissue bridge connecting the suboccipital muscles to the spinal dura mater, and it has been proven to be a normal common existing structure in humans and mammals. Some scholars believe that the suboccipital muscles can serve as a dynamic cerebrospinal fluid (CSF) pump via the MDB, and they found head rotations promote the CSF flow in human body, which provided evidence for this hypothesis. Head movement is a complex motion, but the effects of other forms of head movement on CSF circulation are less known. The present study explored the effects of head-nodding on CSF circulation. The CSF flow of 60 healthy volunteers was analyzed via cine phase-contrast magnetic resonance imaging at the level of the occipitocervical junction before and after one-minute-head-nodding period. Furthermore, the CSF pressures of 100 volunteers were measured via lumbar puncture before and after 5 times head-nodding during their anesthetizing for surgical preparation. As a result, it was found that the maximum and average CSF flow rates at the level of the upper border of atlas during ventricular diastole were significantly decreased from 1.965 ± 0.531 to 1.839 ± 0.460 ml/s and from 0.702 ± 0.253 to 0.606 ± 0.228 ml/s respectively. In the meantime, the changes in the ratio of cranial and caudal orientation of the net flow volume were found differed significantly after the one-minute-head-nodding period (p = 0.017). And on the other hand, the CSF pressures at the L3–L4 level were markedly increased 116.03 ± 26.13 to 124.64 ± 26.18 mmH2O. In conclusion, the head-nodding has obvious effects on CSF circulation and head movement is one of the important drivers of cerebrospinal fluid circulation. We propose that the suboccipital muscles, participating in various head movements, might pull the dura sac via the myodural bridge, and thus, head movement provides power for the CSF circulation. [ABSTRACT FROM AUTHOR]

Pediatric craniopharyngioma is typically characterized by cystic changes and calcifications. It can grow from the suprasellar area to the posterior fossa (4%). This work reports that it is very rare for craniopharyngioma to grow from the suprasellar area to or beyond the level of the foramen magnum. Twelve patients with this disease have undergone one or several microsurgeries, and the microsurgical approaches are different. Among them, two cases died, and most of the remaining patients had certain complications such as endocrine dysfunction, nerve palsy, and subdural effusion. We treated two patients whose tumors had grown to the level of the foramen magnum, one of which reached C2 levels. Both cases were treated with a neuroendoscopy. There were no deaths and no complications. Our cases are the longest follow-up of this type of craniopharyngioma. [ABSTRACT FROM AUTHOR]

Background: Key hole surgery was recruited for MVD surgery since the maneuver is through the small space between the cerebellum and temporal/occipital bone. However, even small wounds can cause severe postoperative pain if there is significant tissue damage. Attention has been given to the size of the craniotomy rather than to the skin incision or soft tissues such as muscles. Method: Suboccipital muscle dissection focusing on splitting the splenius capitis muscle was presented. The dura was reapproximated without additional dissection to harvest a fascia graft. Conclusion: Muscle injury should be minimized to alleviate postoperative pain. [ABSTRACT FROM AUTHOR]

Diffusion MRI paired with tractography has facilitated a non-invasive exploration of many association, projection, and commissural fiber tracts. However, there is still a scarcity of research studies related to intralobar association fibers. The Dejerines' (two of the most notable neurologists of 19th century France) gave an in-depth description of the intralobar fibers of the occipital lobe. Unfortunately, their exquisite work has since been sparsely cited in the modern literature. This work gives a modern description of many of the occipital intralobar lobe fibers described by the Dejerines. We perform a virtual dissection and reconstruct the tracts using diffusion MRI tractography. The dissection is guided by the Dejerines' treatise, Anatomie des Centres Nerveux. As an accompaniment to this article, we provided a French-to-English translation of the treatise portion concerning five intra-occipital tracts, namely: the stratum calcarinum, the stratum proprium cunei, the vertical occipital fasciculus of Wernicke, the transverse fasciculus of the cuneus and the transverse fasciculus of the lingual lobule of Vialet. It was possible to reconstruct all but one of these tracts. For completeness, the recently described sledge runner fasciculus, although not one of the Dejerines' tracts, was identified and successfully reconstructed. Bugain et al perform a virtual dissection and reconstruct the occipital intralobar tracts using diffusion MRI tractography. They provide a modern anatomical depiction of what had originally been described by the Dejerines in the 19th century, as well as a complete translation of the original text. [ABSTRACT FROM AUTHOR]

Action is a medium of collecting sensory information about the environment, which in turn is shaped by architectural affordances. Affordances characterize the fit between the physical structure of the body and capacities for movement and interaction with the environment, thus relying on sensorimotor processes associated with exploring the surroundings. Central to sensorimotor brain dynamics, the attentional mechanisms directing the gating function of sensory signals share neuronal resources with motor-related processes necessary to inferring the external causes of sensory signals. Such a predictive coding approach suggests that sensorimotor dynamics are sensitive to architectural affordances that support or suppress specific kinds of actions for an individual. However, how architectural affordances relate to the attentional mechanisms underlying the gating function for sensory signals remains unknown. Here we demonstrate that event-related desynchronization of alpha-band oscillations in parieto-occipital and medio-temporal regions covary with the architectural affordances. Source-level time–frequency analysis of data recorded in a motor-priming Mobile Brain/Body Imaging experiment revealed strong event-related desynchronization of the alpha band to originate from the posterior cingulate complex, the parahippocampal region as well as the occipital cortex. Our results firstly contribute to the understanding of how the brain resolves architectural affordances relevant to behaviour. Second, our results indicate that the alpha-band originating from the occipital cortex and parahippocampal region covaries with the architectural affordances before participants interact with the environment, whereas during the interaction, the posterior cingulate cortex and motor areas dynamically reflect the affordable behaviour. We conclude that the sensorimotor dynamics reflect behaviour-relevant features in the designed environment. [ABSTRACT FROM AUTHOR]

The paracondylar process is an exostosis, situated lateral to the occipital condyles, which expands towards the transverse process of the atlas. The epitransverse process of the atlas is a bony outgrowth that extends from the transverse process towards the occiput. Ponticulus posterior is a bony bridge that spans from the lateral mass of the atlas towards the posterior extremity of the vertebral artery groove. They are important anatomical variations. In this article, we analyze a rare situation of concomitant presence of ponticulus posterior, foramen arcuate, paracondylar process and epitransverse process, all of them situated on the right side of an individual with artificial cranial deformation from the fifth century AD. The paracondylar process and the epitransverse process form an accessory atlantooccipital joint. The expression of these variations, though under genetic influence, might have also been influenced by artificial cranial deformation. To our knowledge, this association has not been reported. The epitransverse process and the ponticulus posterior are important because of the positional relationship with the vertebral artery on which they may exert compression effects generating blood flow disorders. The paracondylar process is located at the insertion of rectus capitis lateralis, an important surgical landmark, which could be affected by the presence of the paracondylar process, thus leading to possible difficulties in orientation and iatrogenic trauma. This case contributes to extending the knowledge regarding anatomical variations, being of great use to the contemporary medical field, especially surgery. [ABSTRACT FROM AUTHOR]

There is much debate within the forensic community around the indications that suggest a head injury sustained by a child resulted from abusive head trauma, rather than from accidental causes, especially when a fall from low height is the explanation given by a caregiver. To better understand this problem, finite element models of the paediatric head have been and continue to be developed. These models require material models that fit the behaviour of paediatric head tissues under dynamic loading conditions. Currently, the highest loading rate for which skull data exists is 2.81 ms−1. This study improves on this by providing preliminary experimental data for a loading rate of 5.65 ± 0.14 ms−1, equivalent to a fall of 1.6 m. Eleven specimens of paediatric cranial bone (frontal, occipital, parietal and temporal) from seven donors (age range 3 weeks to 18 years) were tested in three-point bending with an impactor of radius 2 mm. It was found that prompt brittle fracture with virtually no bending occurs in all specimens but those aged 3 weeks old, where bending preceded brittle fracture. The maximum impact force increased with age (or thickness) and was higher in occipital bone. Energy absorbed to failure followed a similar trend, with values 0.11 and 0.35 mJ/mm3 for age 3 weeks, agreeing with previously published static tests, increasing with age up to 9 mJ/mm3 for 18-year-old occipital bone. The preliminary data provided here can help analysts improve paediatric head finite element models that can be used to provide better predictions of the nature of head injuries from both a biomechanical and forensic point of view. [ABSTRACT FROM AUTHOR]

Purpose: The occipital bone is located on the boundary between the membranous and cartilage bones and contains a wide variety of accessory sutures. In this study, we describe the age distribution of pediatric patients who are less than 2 years of age with occipital cranial sutures using a three-dimensional computed tomography (3D-CT). Methods: A total of 167 consecutive patients who are less than 2 years of age and underwent computed tomography for head trauma were included in this study. Results: Based on the results of this study, various types of sutures were observed among the pediatric participants. In particular, superior median fissures, mendosal sutures, other interparietal segment's accessory sutures, and interparietal sutures were noted in 21%, 35%, 9%, and 6% of the participants, respectively. Additionally, Wormian bones within the lambdoid suture were noted in 32% of the patients. The median age of children with superior median fissure and mendosal suture was 0 month. Meanwhile, superior median fissure was not observed among children older than 5 months of age. In this population, 13 patients (8%) were found to have skull fracture. Conclusions: Knowledge of the normal cranial anatomy and developmental patterns of cranial sutures is crucial in the evaluation of questionable fractures in the occipital region. A combination of 3D-CT and axial bone window imaging is useful in differentiating normal structures from pathological changes in the cranium. [ABSTRACT FROM AUTHOR]

Introduction: Sagittal craniosynostosis represents the most frequent simplex skull suture pathology. There are currently several operative approaches to this defect. Minimally invasive techniques are preferred for young infants. Since July 2017, we have employed endoscopically assisted craniectomies followed by cranial orthosis. Gradually, we have developed our modified technique, the minimally invasive endoscopically assisted remodelation (MEAR). Surgical technique: MEAR is a combination of principles gained from classical cranial vault remodeling techniques and minimal invasive approaches. The long and wider lateral osteoectomies performed in the parietal and occipital bones along with loosening of the periosteum and dura adhesions at the lambdoid sutures lead to early correction of parieto-occipital dimensions. Results: Thirty-one consecutive patients with scaphocephaly underwent MEAR. The median preoperative cephalic index of 67 units (P25:63.3, P75:70) was improved to a median postoperative cephalic index of 77 units (P25:75, P75: 81). Sufficient correction was achieved in all patients. Cranial orthosis was needed for a median of 1.5 months (P25:1, P75:2). We had no major surgical complications in this pilot series. Conclusions: With MEAR, we have achieved good cosmetic results. Duration of cranial orthosis was significantly shortened compared to conventional endoscopic-assisted procedures. [ABSTRACT FROM AUTHOR]

Purpose: The most frequent impact sites for head injury patients who require surgical intervention are the temporo-parietal regions. However, most recent guidelines for indication of neuroimaging for head injury sparsely address the impact site as a risk factor. Our purpose was to determine the association between the site of impact in a minor mechanism pediatric head injury and neurosurgical intervention. Method: A retrospective cohort study of head injury patients seen between 2000 and 2016 in a large trauma center was carried out. We looked at all children ages 0–18 years who underwent neurosurgical intervention for head traumas. A major mechanism was defined as a fall of >1 m, being struck by a fast-flying object, or a motor collision involving an estimated speed of >40 kph. All other mechanisms were classified as minor. Results: Out of 533 patients, we excluded patients with non-accidental trauma, patients with a relevant chronic illness, patients with a major mechanism of injury, and patients with missing important data, leaving 43 as the study group. Of the 43 patients with a minor mechanism, none had a site of impact that was outside the temporo-parietal region. Conclusion: We studied one of the largest cohorts of pediatric patients undergoing neurosurgical intervention for a head injury. In our cohort, none of the children who sustained a minor mechanism of injury suffered a site of impact in the occipital or frontal bone regions outside the temple region. These data suggest that injury location should be considered in assessing the need for neuroimaging in minor mechanism head trauma patients. [ABSTRACT FROM AUTHOR]

We describe five cases of fatally injured males (occupational accident, car driver, pedestrian, motorcyclist and suicidal jump from great height) with one universal autopsy finding – the presence of brain tissue in one or both auditory canals. Internal examination revealed that all victims had multiple head fractures with dura lacerations. In four cases, the petrous part of the temporal bone was fractured (hinge fracture), while in one case the fracture of both the petrous part of the temporal bones and the occipital bone (ring fracture) was present. In all of these cases, considerable pressure was applied to the head, pushing brain tissue equally in all directions (due to incompressibility of the tissue). The tissue followed the path of least resistance, going through the lacerated dura into the fractured petrous part of the temporal bones and finally reaching the middle ear cavity and auditory canal. This phenomenon is almost exclusively encountered in closed-head injuries. In an open-head injury, brain tissue would be expelled through the open bone fracture and scalp wound. The presence of brain tissue in the ears could indicate a hinge or ring fracture in a closed-head injury which occurred as the result of excessive impulse force or considerable pressure applied to the head, i.e. the head was compressed and/or squeezed. [ABSTRACT FROM AUTHOR]

Introduction: Quadrigeminal arachnoid cyst (QAC) associated with encephalocele is rare; and while some treatments have been developed in recent years, no definite therapeutic approach for QAC has been established. Endoscopic treatment for arachnoid cyst is gaining popularity because it is relatively less invasive to the normal brain tissues. Case presentation: The patient, a 4-year-old girl, presented with QAC associated with congenital occipital encephalocele. At the age of 1 month, repair of the perinatal encephalocele had been performed at another institute. An asymptomatic arachnoid cyst remained in the posterior fossa, which was closely monitored with follow up. At age 4 years, the patient started to complain of headache, which gradually increased in both strength and frequency. Magnetic resonance imaging (MRI) revealed cerebellar compression due to cyst enlargement. We performed neuroendoscopic cyst fenestration with an occipital bone approach. Post-operative MRI showed reduced size of the cyst, and the headache dramatically improved and resolved. Discussion: The standard treatment of QAC is still controversial; however, our successful use of endoscopic fenestration toward the third ventricle indicates its efficacy and safety. QACs have been classified into 3 types based on their expansion mechanisms; our case might suggest another possible mechanism of QAC development. Conclusion: In our case, endoscopic cyst fenestration was successful for QAC with perinatal encephalocele. However, long-term follow-up and analysis of similar cases are needed to determine its effectiveness. [ABSTRACT FROM AUTHOR]

The limbic system is a phylogenetically old, behaviorally defined system that serves as a center for emotions. It controls the expression of anger, fear, and joy and also influences sexual behavior, vegetative functions, and memory. The system comprises a collection of tel-, di-, and mesencephalic structures whose components have evolved and increased over time. Previous animal research indicates that the anterior nuclear group of the thalamus (ANT), as well as the habenula (Hb) and the adjacent mediodorsal nucleus (MD) each play a vital role in the limbic circuitry. Accordingly, diffusion imaging data of 730 subjects obtained from the Human Connectome Project and the masks of six nuclei (anterodorsal, anteromedial, anteroventral, lateral dorsal, Hb, and MD) served as seed regions for a direct probabilistic tracking to the rest of the brain using diffusion-weighted imaging. The results revealed that the ANT nuclei are part of the limbic and the memory system as they mainly connect via the mammillary tract, mammillary body, anterior commissure, fornix, and retrosplenial cortices to the hippocampus, amygdala, medio-temporal, orbito-frontal and occipital cortices. Furthermore, the ANT nuclei showed connections to the mesencephalon and brainstem to varying extents, a pattern rarely described in experimental findings. The habenula—usually defined as part of the epithalamus—was closely connected to the tectum opticum and seems to serve as a neuroanatomical hub between the visual and the limbic system, brainstem, and cerebellum. Finally, in contrast to experimental findings with tracer studies, directly determined connections of MD were mainly confined to the brainstem, while indirect MD fibers form a broad pathway connecting the hippocampus and medio-temporal areas with the mediofrontal cortex. [ABSTRACT FROM AUTHOR]

AIMS: Visual snow is a neurological condition, for which an effective treatment has not been established. The aim of this study was to fi nd whether Repetitive Transcranial Magnetic Stimulation (rTMS) can improve the state of patients suffering from visual snow. To our knowledge, no other group has tested this method in the treatment of visual snow. METHODS: We applied rTMS of 10 and 10+1 Hz on the visual cortices of 9 patients with visual snow. Sham stimulation with the vertex as the target site was also tested. As a method of assessment, we used visual evoked potentials, questionnaires and visual snow diaries. For data evaluation, we used the Paired Sample T-test separately for each stimulation type. RESULTS: The Paired Sample T-test revealed a decreased sum of visual snow intensities extracted from visual snow diaries in the week after 10+1 Hz stimulation as compared to the figure in the week before (p=0.02). CONCLUSION: We detected a trend indicating an improvement of patients' condition based on the data from visual snow diaries. Research on a larger group of patients is required to confirm these findings; however, our study provides a framework to build upon (Tab. 4, Fig. 1, Ref. 22). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

From the first half of the twentieth century to the present day, injuries and fatalities from captive-bolt livestock stunners are a major topic in forensic medicine. The vast majority of cases account for suicides with the frontal, temporal, parietal, and occipital regions being the most common sites of entrance (in descending order of frequency). Due to the limited length of the bolt, the corresponding wound channel within the braincase is only several centimeters long. It has been a controversial subject for a long time, whether the skin-bone complex punched out by the conically grooved end of the steel rod may act as a "secondary projectile" being propelled beyond the actual path of the bolt. To answer this question, experimental shots from various types of captive bolt-guns were fired to simulants. Video-documentation employing a high-speed motion camera showed that the punched-out pieces of skin and bone did not move further than the bolt. Thus, a secondary extension of the total wound channel could not be observed. However, the suction effect caused by the bolt's rearward movement may induce a slight retrograde displacement of the skin-bone complex. [ABSTRACT FROM AUTHOR]

External Occipital Protuberance (EOP) enlargement has been recently reported to increase in young adults, with a putative link with postural factors such as the use of smartphones. This study aims to analyze finely the changes in prevalence and size of EOP enlargement in millennials, throughout the smartphone era (2011 – 2019). Anonymized head Computerized Tomography (CT) examinations from patients aged 18-30 in 2011 (n = 205) or 2019 (n = 240), were reviewed to assess the type of EOP and to measure its volume in case of enlargement. Additional CT analyses were performed on two ancient skulls, from a XVIth century young male and a young female Egyptian mummy. There was no significant evolution in the prevalence of EOP enlargement between 2011 (92/205, 44.9%) and 2019 (106/240; 44.2%) (P = 0.92). There was no significant evolution either in the distribution of enlarged EOP volumes (P = 0.14) or of EOP types (P = 0.92) between 2011 and 2019. In the meantime, rates of smartphone ownership in millennials rose from 35% to 98%. Compared to 2019 volumes, the Egyptian mummy displayed an EOP enlargement corresponding to the 85th percentile for young women, and the XVIth century skull to the 73rd percentile for young men. In conclusion, on a population scale, prevalence and volume of enlarged EOP in millennials remain stable between 2011 and 2019, which makes the impact of rapidly growing modern environmental factors on EOP changes unlikely. EOP enlargement was also already present in ancient skulls from young individuals, with measurements within today's upper ranges. [ABSTRACT FROM AUTHOR]

Background: Caenolestids are a group of poorly known South American marsupials with a restricted distribution in Páramo and Subpáramo environments of the Andes from Colombia and western Venezuela to Bolivia (represented by the genera Caenolestes and Lestoros), and Valdivian rainforest in southern Chile (including a separate population in Chiloé Island) and Argentina, where a single species lives: the Long-nosed shrew opossum (Rhyncholestes raphanurus). The objectives of this work were to analyze the intraspecific variability of R. raphanurus, which includes an anatomical description of the skull and dentition, describe its geographic variation, test for sexual dimorphism, and assess potential differences between continental and Island populations. Methods: Linear Mossimann-transformed variables were used to assess sexual differences within a large population (La Picada), compare sexes within other continental populations, and in a separate analysis, compare continental from Island samples. A full model Principal Components Analysis was performed to assess differences between males and females of the continental and Island populations. A thorough description of the skull and teeth of the species and comparisons with other living Caenolestidae is presented. Results: Rhyncholestes raphanurus presents little geographic variation, even between Island and continental populations. Similarly, we found no significant difference between sexes of this species in cranial and dental measurements. We provide a detailed description of cranial morphology and its variation, and also, the first description of the occipital bones, which haven't been previously described for any Paucituberculata. Conclusions: Comparative studies of continental and Chiloé Island specimens support the treatment of R. raphanurus as a single valid species, especially since morphologic and morphometric differences fall within the extremes of continental populations. The morphology of R. raphanurus clearly separates this genus from other extant Caenolestidae, and in a much greater degree than the differences found between Lestoros and Caenolestes. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between chronologic age, mandibular condyle cortication, and sphenooccipital synchondrosis (SOS) fusion. Methods: Cone Beam Computed Tomography data of 253 patients were retrospectively evaluated. Mandibular condyle cortication was divided into three classes as Types I, II, and III. SOS fusion grade was categorized using a four-stage system (0–3). These variables were evaluated in relation to age and sex. Results: There were significant positive relationships between age and condyle cortication, and between age and SOS fusion stage and between cortication type and SOS fusion stage. Conclusion: Due to the positive correlation between the degree of SOS fusion stage, the condyle cortication type, and the chronological age, these indicators can be used for age estimation. [ABSTRACT FROM AUTHOR]