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Introduction: Three-dimensional measurements of intracranial volume (ICV) can guide clinical management of brain and skull disorders. However, widespread clinical access is limited by the scarcity of software methods for analyzing CT scans, which are more available than MRI images, and the inaccessibility of proprietary and expensive commercial software. The presented method can calculate ICV from CT scans, using an open-source software, 3D Slicer. Methods: The open-source workflow was optimized with a data-driven approach to find the optimal parameters for ICV accuracy. The accuracy of the open-source method was determined by comparing it to commercial and proprietary software with CT scans of pediatric hydrocephalic macrocephaly patients with craniosynostosis undergoing total vault reconstruction (N = 5 patients,15 scans). Results: An open-source pipeline that combines an initial semi-automatic segmentation of a coronal CT reconstruction with a fully automatic segmentation minimizes the ICV error. The open-source method shows excellent agreement with both the commercial and proprietary software methods (R2 = 0.998 and 95% confidence interval of best-fit line slope: [0.986; 1.047], [0.985;1.066] respectively). The mean percent difference of ICV measurements of the open-source software from the commercial software was −0.56% [95% CI: −1.08%, −0.028%] and from the proprietary software was −0.07% [95% CI: −1.26%, 1.1%]. The mean percent difference of ICV measurements of the commercial software from the proprietary software was 0.36% [95% Confidence Interval: −0.61%, 1.32%]. Conclusions: This is the first study comparing an open-source method for measuring ICV with commercial and proprietary options. A high degree of fidelity was found, confirming this open-source method as a viable option for clinicians who are looking to incorporate ICV measurements into their practice. [ABSTRACT FROM AUTHOR] more...

A 15-year-old male presented at a neurosurgeon's office following a traffic accident. A CT scan revealed bone deficiency in the temporoparietal area. The surgical solution involved implanting a 3D-printed prosthesis into the skull. Axial 3D created the model using stereolithography 3D printing technology with Poly Methyl Methacrylate (PMMA). The use of 3D printing as a surgical aid is gaining popularity. Our experience with the presurgical model demonstrates its utility in individualized surgical planning for skull defects. [ABSTRACT FROM AUTHOR] more...

Background: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. [ABSTRACT FROM AUTHOR] more...

Paediatric skull lesions are commonly identified on imaging. They can be challenging to image, given their location and size, and often require several imaging modalities to narrow down the differential diagnosis. Accurate diagnosis of these lesions is paramount because the clinical therapy can vary tremendously. In this review, we provide a simple and systematic approach to clinical-radiological features of primary skull lesions. We highlight the imaging characteristics and differentiate pathologies based on imaging appearances. We also accentuate the role of cross-sectional imaging in lesion identification and management implications. [ABSTRACT FROM AUTHOR] more...

Precise and efficient genetic manipulations have enabled researchers to understand gene functions in disease and development, providing a platform to search for molecular cures. Over the past decade, the unprecedented advancement of genome editing techniques has revolutionized the biological research fields. Early genome editing strategies involved many naturally occurring nucleases, including meganucleases, zinc finger nucleases, and transcription activator-like effector-based nucleases. More recently, the clustered regularly interspaced short palindromic repeats (CRISPR) / CRISPR-associated nucleases (CRISPR/Cas) system has greatly enriched genetic manipulation methods in conducting research. Those nucleases generate double-strand breaks in the target gene sequences and then utilize DNA repair mechanisms to permit precise yet versatile genetic manipulations. The oral and craniofacial field harbors a plethora of diseases and developmental defects that require genetic models that can exploit these genome editing techniques. This review provides an overview of the genome editing techniques, particularly the CRISPR/Cas9 technique, for the oral and craniofacial research community. We also discuss the details about the emerging applications of genome editing in oral and craniofacial biology. [ABSTRACT FROM AUTHOR] more...

The article offers a practice parameter on how to conduct a diagnostic ultrasound examination of the extracranial head and neck. The parameter offers information on equipment necessary and details relating to the examination. Brief information on the ALARA (as low as reasonable achievable) principle and its medical application are also provided. more...

Purpose: The effects of premature fusion of one coronal suture cause skull and orbital alterations in term of side-to-side asymmetry. This study aimed to quantify the cranio-orbital complex changes related to the severity of skull base dysmorphology in patients with unicoronal synostosis.Methods: Twenty-four infants affected by unicoronal synostosis were subdivided in three subgroups according to the severity of skull base deformity and their high-resolution CT images were quantitatively analyzed (groups IIa, IIb, III). Dimensions of cranial fossae, intracranial volume (ICV), ICV synostotic and ICV non synostotic side, whole brain volume (WBV), orbital volumes (OV), ICV/WBV, ICVsynostotic/ICVnon-synostotic, and OVsynostotic/OVnon-synostotic were evaluated.Results: Asymmetry and reduction in the growth of the anterior and middle fossae were found in all groups while asymmetry of the posterior cranial fossa was found only in IIb and III groups. In all groups, ICV, WBV, and ICV/WBV were not significantly different while ICVsynostotic/ICVnon-synostotic and OVsynostotic/OVnon-synostotic resulted significant difference (p < 0.05). ICVsynostotic side resulted reduction only in group III. OV on the synostotic side was not significantly reduced although a trend in progressively reducing volumes was noted according to the severity of the group.Conclusion: Skull and orbital changes revealed a side-to-side asymmetry but the effects of the premature synostosis were more severe in group III suggesting an earlier timing of premature unicoronal synostosis in group III with respect to the other groups. The assessment of the skull base deformity might be an indirect parameter of severity of skull orbital changes and it might be useful for surgical planning. [ABSTRACT FROM AUTHOR] more...

Introduction: Surgery for craniosynostosis remains a crucial element in successful management. Intervention by both endoscopic and open approaches has been proven effective. Given the differences in timing and indications for these procedures, differences in perioperative outcomes have yet to be thoroughly compared between the two approaches. The aim of the systematic review and meta-analysis was to assess the available evidence of perioperative outcomes between the two approaches in order to better influence the management paradigm of craniosynostosis.Methods: We followed recommended PRISMA guidelines for systematic reviews. Seven electronic databases were searched to identify all potentially relevant studies published from inception to February 2018 which were then screened against a set of selection criteria. Data were extracted and analyzed using meta-analysis of proportions.Results: Twelve studies satisfied all the selection criteria to be included, which described a pooled cohort involving 2064 craniosynostosis patients, with 965 (47%) and 1099 (53%) patients undergoing surgery by endoscopic and open approaches respectively. When compared to the open approach, it was found that the endoscopic approach conferred statistically significant reductions in blood loss (MD = 162.4 mL), operative time (MD = 112.38 min), length of stay (MD = 2.56 days), and rates of perioperative complications (OR = 0.58), reoperation (OR = 0.37) and transfusion (OR = 0.09), where all p < 0.001.Conclusion: Both endoscopic and open approaches for the surgical management of craniosynostosis are viable considerations. The endoscopic approach confers a significant reduction in operative and postoperative morbidity when compared to the open approach. Given that specific indications for either approach should be considered when managing a patient, the difference in perioperative outcomes remain an important element of this paradigm. Future studies will validate the findings of this study and consider long-term outcomes, which will all contribute to rigor of craniosynostosis management. [ABSTRACT FROM AUTHOR] more...

Objectives: The aim of this study was to simulate low dose paediatric head CT images with different noise levels corresponding to various tube current time product values and assess simulated image suitability in non-syndromic craniosynostosis diagnostics.Method: 29 paediatric patients who underwent head CT examinations for cranial deformity were enrolled in the study. The low dose CT images, corresponding to 120 kV and 120 mAs, 100 mAs, 80 mAs, 50 mAs and 13 mAs settings, were synthesised by adding noise to original data. Three researchers evaluated suitability for diagnostics of original and simulated images by using questionnaire assessing image suitability.Result: 174 separate cases (containing 1 axial and 1 3D image) were evaluated. Percentage of images evaluated as suitable for diagnosis were 98.9% on original images, 100% on 120 mAs, 100% on 100 mAs, 97.1% on 80 mAs, 96.6% on 50 mAs and 96% on 13 mAs.Conclusions: Images registered with 120 kV 13 mAs can be used to diagnose non-syndromic craniosynostosis with statistically same accuracy as with standard protocol and correspond to decrease of effective dose from 4.98 mSv to 0.33 mSv (median values). [ABSTRACT FROM AUTHOR] more...

Background: The objective of this work is to present a review of all reports involving the management of unicoronal synostosis with distraction osteogenesis (DO). Also, we have innovated a new method in the treatment of cases of anterior plagiocephaly at a young age using DO. Methods: We present a case in which anterior plagiocephaly was treated by DO of both metopic and hemicoronal sutures in a 4-month-old female patient. A comprehensive systematic literature review was completed using the search terms “distraction osteogenesis,” “unicoronal synostosis,” “anterior plagiocephaly,” and “craniosynostosis.” We excluded all experimental articles and reviewed clinical reports detailing the use of DO in the management of unicoronal synostosis. Results: The study sample of this review consisted of 16 reports published over a period of 17 years that were analyzed in detail. The total number of patients treated by DO was 120, and the mean age at operation was 12 months. In the case presented, successful correction of the unicoronal synostosis was achieved. Conclusion: Hemicoronal and metopic suture distraction in anterior plagiocephaly achieves considerable improvement in the midline shift of the anterior cranial base and naso-orbital complex. [ABSTRACT FROM AUTHOR] more...

The most prominent issues in paleopathology concerning skull lesions are skull trepanation and artificial deformation of the skull. From the very beginnings of this scientific field, these two groups of alterations have been the focus of interest. Since the second half of the 19th century, countless pathologists, surgeons and ethnologist have dealt with this issue. The interest is still great. Nevertheless, numerous questions regarding skull trepanation and artificial deformation are yet to be answered. The first trepanned skull finds were discovered in France and Hungary. The finds in Hungary are interesting because a large number of trepanned skulls were found in a relatively small area. On the skull remains found in the grave discovered in the Òmoravica-Koplaló cemetery and labelled MO-90, left of the Sutura sagittalis there is a hole about 1cm in diameter. There are no pathological lesions along the edge or around the hole. [ABSTRACT FROM AUTHOR] more...

Background Cranial osteomyelitis is a rare but potentially life-threatening condition that requires early diagnosis with prompt and appropriate management by neurosurgeons to prevent further central nervous system complications. Methods The literature in the Medline database was comprehensively reviewed with the keywords “cranial osteomyelitis,” “skull base osteomyelitis (SBO),” “central skull base osteomyelitis,” and “temporal bone osteomyelitis.” Items in the reference list of each article relevant to the objective of this study were reviewed. Results This review produced 183 articles: 13 book chapters, 24 case reports, 17 case series, 98 original articles, 30 review articles, and 1 meta-analysis. We classified cranial osteomyelitis as sinorhino-otogenic, including anterior, middle, and posterior skull base osteomyelitis; and non-sinorhino-otogenic, including iatrogenic, posttraumatic, hematologic, and osteomyelitis with other causes. Conclusions New diagnostic modalities, the introduction of broad-spectrum antibiotics, and recent advances in neurosurgical procedures have led to a decrease in the rate of treatment failure in cranial osteomyelitis. Early recognition of initial nonspecific symptoms is key to diagnosing and managing this treatable but life-threatening condition. Early identification of the causative pathogen, appropriate broad-spectrum antibiotic therapy over a period of 8–20 weeks, and aggressive surgical debridement are essential for managing cranial osteomyelitis. On the other hand, inadequate treatment is responsible for refractory cases and poses a great diagnostic challenge. A new classification dividing cranial osteomyelitis into sinorhino-otogenic versus nonsinorhino-otogenic groups could prove valuable for clinical communication and treatment. [ABSTRACT FROM AUTHOR] more...

Loss-of-function mutations in GLI3 and IHH cause craniosynostosis and reduced osteogenesis, respectively. In this study, we show that Ihh ligand, the receptor Ptch1 and Gli transcription factors are differentially expressed in embryonic mouse calvaria osteogenic condensations. We show that in both Ihh-/- and Gli3Xt-J/Xt-J embryonic mice, the normal gene expression architecture is lost and this results in disorganized calvarial bone development. RUNX2 is a master regulatory transcription factor controlling osteogenesis. In the absence of Gli3, RUNX2 isoform II and IHH are upregulated, and RUNX2 isoform I downregulated. This is consistent with the expanded and aberrant osteogenesis observed in Gli3Xt-J/Xt-J mice, and consistent with Runx2-I expression by relatively immature osteoprogenitors. Ihh-/- mice exhibited small calvarial bones and HH target genes, Ptch1 and Gli1, were absent. This indicates that IHH is the functional HH ligand, and that it is not compensated by another HH ligand. To decipher the roles and potential interaction of Gli3 and Ihh, we generated Ihh-/-;Gli3Xt-J/Xt-J compound mutant mice. Even in the absence of Ihh, Gli3 deletion was sufficient to induce aberrant precocious ossification across the developing suture, indicating that the craniosynostosis phenotype of Gli3Xt-J/Xt-J mice is not dependent on IHH ligand. Also, we found that Ihh was not required for Runx2 expression as the expression of RUNX2 target genes was unaffected by deletion of Ihh. To test whether RUNX2 has a role upstream of IHH, we performed RUNX2 siRNA knock down experiments in WT calvarial osteoblasts and explants and found that Ihh expression is suppressed. Our results show that IHH is the functional HH ligand in the embryonic mouse calvaria osteogenic condensations, where it regulates the progression of osteoblastic differentiation. As GLI3 represses the expression of Runx2-II and Ihh, and also elevates the Runx2-I expression, and as IHHmay be regulated by RUNX2 these results raise the possibility of a regulatory feedback circuit to control calvarial osteogenesis and suture patency. Taken together, RUNX2-controlled osteoblastic cell fate is regulated by IHH through concomitant inhibition of GLI3-repressor formation and activation of downstream targets. [ABSTRACT FROM AUTHOR] more...

The article discusses a study on surgical management of extensive osteoradionecrosis in nasopharyngeal carcinoma patients with the maxillary swing approach and free muscular flaps. Topics include role of extensive osteoradionecrosis of the skull base as strong pre-disposing factor for life-threatening complications such as carotid artery rupture, and cerebral infection; survival of patients with resolution of pre-treatment symptoms; and use of the method for nasopharyngeal carcinoma patients. more...

The literature data on the incidence of pneumatization of the crista galli based on patients' computed tomography (CT) scans ranges from 3 to 37.5%. This study investigated for the first time the incidence of crista galli pneumatization based on CT scans of human skulls. The study examined 102 randomly selected human skulls (≥20 years of age; 76 males, 26 females). Skulls were scanned in a fixed position using cone beam computed tomography (CBCT) with a field of view of 145 × 130 mm and an isotropic voxel size of 0.25 mm. The scans were recorded in Digital Images and Communications in Medicine format. The CBCT images were analyzed using OnDemand3DTM software. A 2-mm contiguous slice thickness was used in the axial and coronal planes. The width, length, and height (cranial-caudal dimension) of the pneumatized space within the crista galli were measured. The crista galli was found to be pneumatized in even 68 (66.6%) of the 102 skulls. Two types of pneumatized crista galli (PCG) were identified: PCG alone (surrounded by bony walls) and PCG + spongiosis (surrounded by spongy bone). Of the 68 pneumatized skulls, 31 were PCG alone (45.58%) and 37 were PCG + spongiosis (54.42%). The pneumatized regions had a width of 0.9-6.6 mm, length of 2.8-12.9 mm, and height of 3.6-17.1 mm. No statistically significant differences have been found regarding the sex and age. Regarding the proportions of pneumatization, the three types of crista galli have been determined resulting in new, practical classification: type S (small), type M (moderate), and type L (large). The crista galli is not always a compact bone; in some cases, it is filled with spongy bone or pneumatized. In respect of proportions of pneumatization, there are three types of pneumatized crista galli: small, moderate, and large. Pneumatized crista galli can play an important role in clinical work, both as an inflamed sinus or other pathologies (sinusitis cristae galli, mucocoelae) or as a morphologic barrier in neurosurgical approaches to some tumors of the anterior skull base. [ABSTRACT FROM AUTHOR] more...

Genome-wide association studies (GWASs) opened an innovative and productive avenue to investigate the molecular basis of human craniofacial disease. However, GWASs identify candidate genes only; they do not prove that any particular one is the functional villain underlying disease or just an unlucky genomic bystander. Genetic manipulation of animal models is the best approach to reveal which genetic loci identified from human GWASs are functionally related to specific diseases. The purpose of this review is to discuss the potential of zebrafish to resolve which candidate genetic loci are mechanistic drivers of craniofacial diseases. Many anatomic, embryonic, and genetic features of craniofacial development are conserved among zebrafish and mammals, making zebrafish a good model of craniofacial diseases. Also, the ability to manipulate gene function in zebrafish was greatly expanded over the past 20 y, enabling systems such as Gateway Tol2 and CRISPR-Cas9 to test gain- and loss-of-function alleles identified from human GWASs in coding and noncoding regions of DNA. With the optimization of genetic editing methods, large numbers of candidate genes can be efficiently interrogated. Finding the functional villains that underlie diseases will permit new treatments and prevention strategies and will increase understanding of how gene pathways operate during normal development. [ABSTRACT FROM AUTHOR] more...

Purpose: The aim of this study was to investigate the optimal age for starting cranial-remolding-orthosis therapy in children with deformational plagiocephaly. Methods: Medical records of 310 patients with deformational plagiocephaly were retrospectively reviewed and the initial and final cranial vault asymmetry index (CVAI), age when starting therapy, duration of therapy, mean change of CVAI, improvement rate, and treatment success were analyzed. We compared outcomes according to the groups divided by ages starting therapy. Results: There were no significant differences in improvement rate and duration of cranial-remolding-orthosis therapy among patients starting therapy at the age of 3, 4, and 5 months. However, when starting therapy after the age of 6 months, the rates of CVAI improvement were significantly lower and the duration of therapy was significantly increased. Conclusion: Considering the spontaneous resolution effect according to the head growth nature, the age 5 month is the optimal period to start cranial-remolding-orthosis therapy for deformational plagiocephaly. [ABSTRACT FROM AUTHOR] more...

This paper aims to present an algorithm that specifically enhances maxillary sinuses using a novel contrast enhancement technique based on the adaptive morphological texture analysis for occipitomental view radiographs. First, the skull X-ray (SXR) is decomposed into rotational blocks (RBs). Second, each RB is rotated into various directions and processed using morphological kernels to obtain the dark and bright features. Third, a gradient-based block segmentation decomposes the interpolated feature maps into feature blocks (FBs). Finally, the histograms of FBs are equalized and overlaid locally to the input SXR. The performance of the proposed method was evaluated on an independent dataset, which comprises of 145 occipitomental view-based human SXR images. According to the experimental results, the proposed method is able to increase the diagnosis accuracy by 83.45% compared with the computed tomography modality as the gold standard. [ABSTRACT FROM AUTHOR] more...

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In this study 6 pre-operative designs for PMMA based reconstructions of cranial defects were evaluated for their mechanical robustness using finite element modeling. Clinical experience and engineering principles were employed to create multiple plan options, which were subsequently computationally analyzed for mechanically relevant parameters under 50N loads: stress, strain and deformation in various components of the assembly. The factors assessed were: defect size, location and shape. The major variable in the cranioplasty assembly design was the arrangement of the fixation plates. An additional study variable introduced was the location of the 50N load within the implant area. It was found that in smaller defects, it was simpler to design a symmetric distribution of plates and under limited variability in load location it was possible to design an optimal for expected loads. However, for very large defects with complex shapes, the variability in the load locations introduces complications to the intuitive design of the optimal assembly. The study shows that it can be beneficial to incorporate multi design computational analyses to decide upon the most optimal plan for a clinical case. [ABSTRACT FROM AUTHOR] more...

Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse. In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices. We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four bicoronal craniosynostosis patients during PCVO. We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre-distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions. [ABSTRACT FROM AUTHOR] more...

Background Traditionally, the dural venous sinuses have been described only in the cranium. However, anecdotally, during various neurosurgical intradural procedures in the lumbosacral spine, we noticed an intradural collection of blood. With no prior studies on this in the extant medical literature, the following anatomic investigation seemed warranted. Methods Twenty fresh frozen adult cadavers were used for the study. The dural sac was exposed and removed. A 30-gauge needle was inserted into the dura mater while not traversing the full thickness of the dura mater. Once the needle was positioned halfway into the thickness of the dura mater, injection of black ink was attempted. Cross-sections of the dural sac were performed, and the sections were stained using hematoxylin and eosin and examined under a light microscope. Results Spinal venous sinuses were identified between the L5 and S1 levels in 14 (70%) specimens. Transdural vessels were found through the thickness of the dural sac along its entire circumference, but the spinal venous sinus was only identified in the posterior region of the dural sac in the lumbosacral region (L3 to S1). Conclusions Our study identified a dural venous sinus located in the dorsal lumbosacral region and near the midline. We suggest this structure be called the lumbosacral venous sinus. Although the function of such a sinus is speculative, knowledge of its presence might benefit those interpreting imaging of this region, especially with regional pathology such as dural arteriovenous fistulas. [ABSTRACT FROM AUTHOR] more...

Objetive. To determine predictors of effectiveness of airway intubation and its prognostic value, according to the morphology of the skull in dogs. Materials and methods. We performed a descriptive, observational study in two veterinary clinics, in Medellin city, Colombia. 74 dogs were evaluated randomly. All underwent Mallampati, Patil-Aldreti, Cormack-Lehane scale and distance sternum chin separated by skull morphology. Tukey test p≤0.05 were performed in skull morphology and predictive scales; in addition to principal component analysis and predictive scale race. Results. significant statistics and Mallampati between brachycephalic, dolichocephalic and mesocephalic (p=0.00), brachycephalic had difficult intubation, Cormack-Lehane differences were presented also similar between brachycephalic and the other two groups. Exhibited brachycephalic difficult intubation. Patil-Aldreti revealed brachycephalic demonstrate statistical difference from the others, with moderate difficulty. The sternum chin distance, showed no divergence for any of the three groups. Assessment predictor of intubation found that 13.51 % of dogs have difficult intubation, 37.83 % with moderate difficulty and 47.29 % showed slight difficulty for intubation. The average intubation attempts was 1.83 attempts and the average time was 123.43 sec. The main components determined that breeds Bulldog, is predicted by Mallampati and Patil-Aldreti while Pinscher is predicted by Cormack Lehane. Mixed races, is not influenced by a predictor. Conclusions. Brachycephalic type canines are those with greater difficulty of intubation and Mallampati is the main predictor factor. [ABSTRACT FROM AUTHOR] more...

Background. Standard anthropometric methods applied to measurements of the skull differentials are laden with mistakes stemming from the way the measuring devices are built and from a lack of experience on the part of the researchers. To increase objectivity, digital imaging measurements via computer systems were introduced. Objectives. The aim of this research was to assess the asymmetry of the male and female orbit with the application of the new graphic methods: raster graphics and vector graphics. Material and methods. The examination was conducted on 184 well-preserved skulls. The photos were taken by a digital camera with high definition. Orbit asymmetry was examined by determining the distance between the centers of gravity of both orbits and the frontal median line d1 and d2. Then angles α and β were appointed. They are defined as angles between the line that runs through craniometrical points mf and ek on the right side (angle α) and on the left side (angle β), and the frontal median line at their crossing point. Distances r2 and r1, which are allocated points between the frontal median lines (LPP), were also set. Results. Angles α and β were also analyzed while comparing the skulls of both genders. Statistically significant differences were only observed in male skulls. However, differences for both genders were noted in parameters d1 and d2. No statistically significant differences were discovered between men and women for parameters r1 and r2. The groups of women and men were merged, being treated as a population; which resulted in the conclusion that there are no statistically significant differences between these parameters. Conclusions. The skull's asymmetry connected to gender and the asymmetry of the right and left sides of examined craniums can be used in criminal examinations as well as in facial reconstructive surgeries. [ABSTRACT FROM AUTHOR] more...

Backround: Morphological indicators within the cranium for prediction of mandibular growth patterns as reported by Bjork are: (1) inclination of the condylar head (ICH), (2) curvature of mandibular canal (CMC), (3) shape of the lower border of the mandible and specifically depth of the antegonial notch (AN), (4) inclination of the symphysis (ISY), (5) interincisal angle (IIA), (6) intermolar angle (IMA), and (7) lower anterior face height (LAFH). The purpose of this study was to examine the association of these indicators as they relate to extreme skeletal patterns observed in skeletally mature subjects. Materials: The pre-treatment lateral cephalometric radiographs of 395 post-growth subjects were randomly selected from the archives of a university orthodontic department. These were divided in three groups according to their MP-SN angle [normal: 28–36 degrees (G1), hypodivergent: ≤26 degrees (G2), hyperdivergent: ≥38 degrees (G3)]. Results: It was found that only LAFH was correlated to age across all groups. However, within G1, G2, and G3, and between genders, it was found that there were statistically significant differences for all indicators in relation to age, except IMA (P > 0.05). In addition, ISY and IMA had a predictive value lower than the chance level (0.5). Conclusion: Bjork's implant studies have contributed much to understanding facial–skeletal growth; however, this study suggests that their utilization as a tool in classifying extreme skeletal patterns requires careful evaluation of all the parameters involved. [ABSTRACT FROM AUTHOR] more...

Background The C1-C2 joint has multiple degrees of freedom of movement and C1-C2 dislocation (AAD) is often multiplanar. The existing methodology to assess the dislocation is limited to few planes. The object of this study is to redefine and objectively assess congenital AAD in each possible plane, before and after the operation. Methods This study consisted of 95 patients of irreducible congenital AAD operated on with the posterior approach alone. Preoperative and postoperative computed tomography imaging was studied in the axial, coronal, and sagittal planes. The relationship of C1-C2 along with the C1-C2 joint inclination was studied in each plane. The extent and type of dislocation was objectively assessed in each plane (newer indices) and compared with follow-up imaging for correction. The preoperative and postoperative Japenese orthopaedics association scores were compared. Results The commonest variety (61 patients) was a combination of anteroposterior (AP) and vertical C1-C2 dislocation. Five patients had predominant APnteroposterior, 6 vertical, 4 axial rotational, 9 lateral angular tilt, and 3 had lateral transalational. Seven patients had a combination of dislocation in AP, vertical, and rotational planes. AP dislocation was seen with sagittal inclination of C1-C2 joints and vertical dislocation with coronal inclination. Asymmetry in the joint's sagittal inclination added to a rotational component, whereas asymmetry in the coronal angulation caused lateral angular tilt. Pure rotational or lateral translation dislocation had near-normal C1-C2 orientation. Preoperative Japenese orthopaedics association score was worst in the lateral tilt and the lateral translation. Correction in all planes was achieved in all patients. Conclusions The objective assessment of C1-C2 dislocation and joints in each plane was to determine its management and help in achieving multiplanar correction. [ABSTRACT FROM AUTHOR] more...

The skull is essential for protecting the brain from damage, and birth defects involving disorganization of skull bones are common. However, the developmental trajectories and molecular etiologies by which many craniofacial phenotypes arise remain poorly understood. Here, we report a novel skull defect in ciliopathic Fuz mutant mice in which only a single bone pair encases the forebrain, instead of the usual paired frontal and parietal bones. Through genetic lineage analysis, we show that this defect stems from a massive expansion of the neural crest-derived frontal bone. This expansion occurs at the expense of the mesodermally-derived parietal bones, which are either severely reduced or absent. A similar, though less severe, phenotype was observed in Gli3 mutant mice, consistent with a role for Gli3 in cilia-mediated signaling. Excess crest has also been shown to drive defective palate morphogenesis in ciliopathic mice, and that defect is ameliorated by reduction of Fgf8 gene dosage. Strikingly, skull defects in Fuz mutant mice are also rescued by loss of one allele of fgf8 , suggesting a potential route to therapy. In sum, this work is significant for revealing a novel skull defect with a previously un-described developmental etiology and for suggesting a common developmental origin for skull and palate defects in ciliopathies. [ABSTRACT FROM AUTHOR] more...

Craniosynostosisis a defect of the skull caused by premature fusion of one or more cranial sutures. It may be isolated finding or part of a syndrome and affects 1 in every 2,500 live births. Usually multiple sutures are involved and correspond in at least 20% of the cases. Syndromic craniosynostosis can be associated with various dysmorphic features involving the face, skeleton and nervous system. More than 180 syndromes have been reported with craniosynostosis. The aim of this review is to present the clinical and genetic characteristics of the most common types of syndromiccraniosynostosis. [ABSTRACT FROM AUTHOR] more...

The article presents case study of a two-day-old girl who was diagnosed with encephalocele occipitalis amputata. The encephalocele consisted of a cylindrical, broad based skin sac, and the sac had an ulcerated opening. Dissection of the central nervous system showed ecchymotic soft skull, and the posterior fontanel was normal in size. Microscopic examination of the encephalocele occipitalis, vermis, and pons was perfomed. It notes the misuse of the term Chiari IV malformation. more...

Primary dural lymphoma (PDL) refers to a lymphoma with epidural or subdural involvement and is a rare subtype of primary central nervous system lymphoma. Diffuse large B-cell lymphoma (DLBCL) presenting as PDL is extremely rare. The present study reports a case of PDL with skull and scalp involvement in a 56-year-old man. Magnetic resonance imaging (MRI) revealed that the tumor was located under the right parietal inner plate and was attached to the dura mater. Following contrast-enhanced MRI, markedly enhanced tumor signals were observed, and mild homogeneous enhancement was observed in the diploë and soft tissues under the scalp, near the parietal bone. Under general anesthesia, the patient underwent craniotomy and tumor resection. The postoperative pathological diagnosis was DLBCL. Tumors were additionally identified inside the skull and subcutaneous tissues. The patient was administered chemotherapy postoperatively, and the prognosis subsequent to the 4-year follow-up was favorable. Primary malignant lymphoma should be considered in the differential diagnosis of scalp masses and meningeal lesions. Early diagnosis and individualized treatment is closely associated with a favorable outcome. [ABSTRACT FROM AUTHOR] more...

Options for anticoagulation have been expanding constantly during the past few years, providing a greater number of agents for prevention and management of thromboembolic disease. Although heparins and vitamin K antagonists (VKAs) has been used extensively for many decades, their narrow therapeutic range, interactions with other medications and food, and the need for routine monitoring of blood levels have led to the search for less problematic alternatives. Direct oral anticoagulants represent an important advance in anticoagulation therapy, directly inhibiting thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) they represent an effective and safe alternatives to VKAs and heparins in the prevention and treatment of several thromboembolic disorders. DOCAs are associated with a low overall intracranial hemorrhage risk; however, life-threatening bleeding can occur. Reversal agents are approved for some and under development for others, concerns over the lack of antidotes or difficulty in obtaining them has tempered enthusiasm for their use because of the perception of better safety with heparins and VKAs as a result of the availability of effective reversal strategies. Appropriate use of these agents requires knowledge of their individual characteristics, mechanisms of action, pharmacokinetics, ways of monitoring, and when needed, manage patients in need of urgent surgery especially in life-threatening bleeds. This article provides a suggested comprehensive approach to manage patients with intracranial hemorrhage while on direct oral anticoagulants who require an urgent surgical intervention and who cannot wait for plasma concentration to decline. [ABSTRACT FROM AUTHOR] more...

Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG. [ABSTRACT FROM AUTHOR] more...

During growth, individual skull bones overlap at sutures, where osteoblast differentiation and bone deposition occur. Mutations causing skull malformations have revealed some required genes, but many aspects of suture regulation remain poorly understood. We describe a zebrafish mutation in osterix/sp7 , which causes a generalized delay in osteoblast maturation. While most of the skeleton is patterned normally, mutants have specific defects in the anterior skull and upper jaw, and the top of the skull comprises a random mosaic of bones derived from individual initiation sites. Osteoblasts at the edges of the bones are highly proliferative and fail to differentiate, consistent with global changes in gene expression. We propose that signals from the bone itself are required for orderly recruitment of precursor cells and growth along the edges. The delay in bone maturation caused by loss of Sp7 leads to unregulated bone formation, revealing a new mechanism for patterning the skull and sutures. [ABSTRACT FROM AUTHOR] more...

The article presents the case study of a 6-year-old boy presented with a large hairless area on the scalp present since birth. There was no history of seizures, delay in developmental milestones, or visual or auditory complaints. Two-thirds of the patch comprised of an elevated smooth surfaced boggy swelling and the remaining area had atrophic wrinkled skin with underlying skull defect and visible pulsations. A clinical diagnosis of nevus psiloliparus with aplasia cutis congenita was given. more...

Purpose: Our aim was to develop a novel method for characterizing common skull deformities with high sensitivity and specificity, based on two-dimensional (2D) shape descriptors in computed tomography (CT) images. Methods: Between 2003 and 2014, 44 normal subjects and 39 infants with craniosynostosis (sagittal, 29; bicoronal, 10) enrolled for analysis. Mean age overall was 16 months (range, 1-120 months), with a male:female ratio of 56:29. Two reference planes, sagittal (S-plane: through top of lateral ventricle) and coronal (C-plane: at maximum dimension of fourth ventricle), were utilized to formulate three 2D shape descriptors (cranial index [CI], cranial radius index [CR], and cranial extreme spot index [CES]), which were then applied to S- and C-plane target images of both groups. Results: In infants with sagittal craniosynostosis, CI in S-plane (S-CI) usually was <1.0 (mean, 0.78; range, 0.67-0.95), with CR consistently at 3 and a characteristic CES pattern of two discrete hot spots oriented diagonally. In the bicoronal craniosynostosis subset, CI was >1.0 (mean 1.11; range, 1.04-1.25), with CR at −3 and a CES pattern of four discrete diagonally oriented hot spots. Scatter plots underscored the highly intuitive joint performance of CI and CES in distinguishing normal and deformed states. Altogether, these novel 2D shape descriptors enabled effective discrimination of sagittal and bicoronal skull deformities. Conclusions: Newly developed 2D shape descriptors for cranial CT imaging enabled recognition of common skull deformities with statistical significance, perhaps providing impetus for automated CT-based diagnosis of craniosynostosis. [ABSTRACT FROM AUTHOR] more...

We present the fetal MRI characteristics of exencephaly, a rare malformation of the cranium. The fetus was initially misdiagnosed as anencephaly at 14 weeks of estimated gestational age (EGA) and later mislabeled as acrania at 20 weeks of EGA by ultrasound. A confirmatory magnetic resonance imaging (MRI) at 29 weeks of EGA demonstrated findings consistent with exencephaly, which was confirmed after birth. To our knowledge, no full fetal MRI characteristics have been described. We hope to use this case to review the key MRI findings in differentiating exencephaly from other cranial vault defects and to help early diagnosis of exencephaly as the appropriate use of correct nomenclature allows better research while giving parents the most accurate and appropriate counseling. [ABSTRACT FROM AUTHOR] more...

The aim of this trial was to compare two techniques of maxillary dysjunction, with 10 mg/kg tranexamic acid as an adjuvant, in isolated non-segmented Le Fort I procedures. Two hundred patients were randomized to one of four groups: group A, pterygomaxillary dysjunction + saline; group B, tuberosity separation + saline; group C, pterygomaxillary dysjunction + tranexamic acid; and group D, tuberosity separation + tranexamic acid. Primary outcome measures were intraoperative blood loss and operating time, while the secondary outcome measures were surgical field assessment, need for blood transfusion, and duration of hospitalization. The data were analyzed using one-way analysis of variance (SPSS v. 17.0), and the level of significance was set at P < 0.05. Results revealed that group D (tuberosity separation + tranexamic acid) had the least blood loss (mean 172 ml) and shortest operating times (mean 49 min), with the best surgical field. This group also exhibited the lowest drop in postoperative haemoglobin concentration (Hb gm/dl) and packed cell volume (PCV). Five patients, all in group A, required a blood transfusion and had an extra 24 h of hospitalization. This trial revealed that the tuberosity separation technique with the use of tranexamic acid was the best protocol in producing the least blood loss, minimizing the operating time, and providing the best surgical field. [ABSTRACT FROM AUTHOR] more...

Many studies aimed at investigating bone repair have been conducted through animal models in recent years. However, limitations do exist in these models due to varying regeneration potential among different animal species. Even using the same animal, big differences exist in the size of critical size defects (CSD) involving the same region. This study aimed to investigate the standardization of radial bone defect models in rabbits and further establish more reliable CSD data. A total of 40 6-month-old New Zealand white rabbits of clean grade totaling 80 radial bones were prepared for bone defect models, according to the principle of randomization. Five different sizes (1.0, 1.2, 1.4, 1.7 and 2.0 cm) of complete periosteal defects were introduced under anesthesia. At 12 weeks postoperatively, with the gradual increase in defect size, the grades of bone growth were significantly decreased in all 5 groups. X-ray, CT scans and H&E staining of the 1.4, 1.7, and 2.0-cm groups showed lower grades of bone growth than that of the 1.0 and 1.2-cm groups respectively (P < 0.05). Using rabbit radial defect model involving 6-month-old healthy New Zealand white rabbits, this study indicates that in order to be critical sized, defects must be greater than 1.4 cm. [ABSTRACT FROM AUTHOR] more...

The OnControl coaxial biopsy system (Vidacare Corporation, Shavano Park, TX) includes an inner diamond-tipped access needle and hollow biopsy needle that engage with a battery-powered hand drill. Herein, we report the use of this novel device to perform two CT-guided percutaneous skull biopsies. Both procedures were performed without complication and facilitated a pathologic diagnosis. [ABSTRACT FROM AUTHOR] more...

To promote bone regeneration in vivo using critical-size calvarial defect model, hybrid hydrogel was prepared by mixing chitosan with hydroxyapatite (HA) and ultraviolet (UV) irradiation in situ. The hydrosoluble, UV-crosslinkable and injectable Nmethacryloyl chitosan (N-MAC) was synthesized via single-step N-acylation reaction. The chemical structure was confirmed by 1H-NMR and FTIR spectroscopy. N-MAC hydrogel presented a microporous structure with pore sizes ranging from 10 to 60 pm. Approximately 80% cel! viability of N-MAC hydrogel against encapsulated 3T3 cell indicated that N-MAC is an emerging candidate for mimicking native extracellular matrix (ECM). N-MAC hydrogel hybridized with HA was used to accelerate regeneration of calvarial bone using rabbit model. The effects of hybrid hydrogels to promote bone regeneration were evaluated using critical size calvarial bone defect model. The healing effects of injectable hydrogels with/without HA for bone regeneration were investigated by analyzing X-ray image after 4 or 6 weeks. The results showed that the regenerated new bone for N-MAC 100 was significantly greater than N-MAC without HA and untreated controls. The higher HA content in N-MAC/HA hybrid hydrogel benefited the acceleration of bone regeneration. About 50% closure of defect site after 6 weeks postimplantation demonstrated potent osteoinductivity of N-MAC 100 UV-crosslinkable and injectable NMACIHA hybrid hydrogel would allow serving as a promising biomaterial for bone regeneration using the critical-size calvarial defect. [ABSTRACT FROM AUTHOR] more...

Key Clinical Message Aplasia cutis congenita is a disease in which skin, bone, and dura mater can be absent. In majority of the cases it affects the scalp. We report a baby girl born at term with a large scalp and skull defect measuring 9 × 10 cm. Conservative treatment led to complete epithelization. [ABSTRACT FROM AUTHOR] more...

Background. The aim of the study was to review the methods of diagnosis of craniosynostosis and to analyze Vilnius (Lithuania) team experience of surgical treatment, surgical methods, aspects of anesthesia for patients with craniosynostosis and to present early results of surgical treatment. Materials and methods. A retrospective review of all patients with various types of craniosynostosis treated surgically during the period from 1 January 2009 to 31 December 2014 was performed. The following data were analyzed: age, type of deformity, surgical technique, surgical time, methods and course of anesthesia, intra- and postoperative complications, parents' satisfaction, head form. Results. 24 patients were treated. The mean patient's age at the time of surgery was 13.47 ± 8.2 months (min 7.3, max 46.5). Eliminating 3 patients whose age at the time of surgery was over 2 years (24.5, 29 and 46 months, respectively), the mean age of other 21 patients was 10.63 ± 1.77 (min 7.3, max 14.1) months. There were 9 cases of isolated trigonocephaly (37.5%), 7 cases of isolated scaphocephaly (29.2%), 7 cases of isolated anterior plagiocephaly (29.2%) and 1 case of posterior plagiocephaly combined with scaphocephaly (4.17%). All craniosynostoses were diagnosed clinically and diagnosis was confirmed with computed tomographic scanning. The median duration of surgery was 336.47 ± 59.63 minutes (min 308.13, max 364.82). The medium stay in the intensive care unit was 2.53 ± 1.28 days (min. 1.92, max 3.14). In all cases rigid osteosynthesis was performed. 2 children were diagnosed with syndromic craniofacial abnormalities. In 23 (95.83%) cases an intraoperative or postoperative blood transfusion was required. In 24 treated patients there was no mortality. During the early and late postoperative period no infections, CSF leakage and dural tears were observed. No neurological impairments or any signs of neurological deficits were observed by any of the treated patients. In all of cases parents were satisfied with their children's changed head shape and aesthetic results. Conclusions. Cranioplasties for correction of craniosynostosis give good aesthetic results and this is a safe method, which helps to correct the head shape as well as improves the social adaptation of patients. [ABSTRACT FROM AUTHOR] more...

The aim of the present study was to evaluate the effects of transcranial focal electrical stimulation (TFS) on γ-aminobutyric acid (GABA) and glutamate release in the hippocampus under basal conditions and during pilocarpine-induced status epilepticus (SE). Animals were previously implanted with a guide cannula attached to a bipolar electrode into the right ventral hippocampus and a concentric ring electrode placed on the skull surface. The first microdialysis experiment was designed to determine, under basal conditions, the effects of TFS (300 Hz, 200 μs biphasic square pulses, for 30 min) on afterdischarge threshold (ADT) and the release of GABA and glutamate in the hippocampus. The results obtained indicate that at low current intensities (< 2800 μA), TFS enhances and decreases the basal extracellular levels of GABA and glutamate, respectively. However, TFS did not modify the ADT. During the second microdialysis experiment, a group of animals was subjected to SE induced by pilocarpine administration (300 mg/kg, i.p.; SE group). The SE was associated with a significant rise of GABA and glutamate release (up to 120 and 182% respectively, 5 h after pilocarpine injection) and the prevalence of high-voltage rhythmic spikes and increased spectral potency of delta, gamma, and theta bands. A group of animals (SE-TFS group) received TFS continuously during 2 h at 100 μA, 5 min after the establishment of SE. This group showed a significant decrease in the expression of the convulsive activity and spectral potency in gamma and theta bands. The extracellular levels of GABA and glutamate in the hippocampus remained at basal conditions. These results suggest that TFS induces anticonvulsant effects when applied during the SE, an effect associated with lower amino acid release. This article is part of a Special Issue entitled “Status Epilepticus” . [ABSTRACT FROM AUTHOR] more...

Purpose: Experimentally verify a previously described technique for performing passive acoustic imaging through an intact human skull using noninvasive, computed tomography (CT)-based aberration corrections Jones et al. [Phys. Med. Biol. 58, 4981-5005 (2013)]. Methods: A sparse hemispherical receiver array (30 cm diameter) consisting of 128 piezoceramic discs (2.5 mm diameter, 612 kHz center frequency) was used to passively listen through ex vivo human skullcaps (n = 4) to acoustic emissions from a narrow-band fixed source (1 mm diameter, 516 kHz center frequency) and from ultrasound-stimulated (5 cycle bursts, 1 Hz pulse repetition frequency, estimated in situ peak negative pressure 0.11-0.33 MPa, 306 kHz driving frequency) Definity™ microbubbles flowing through a thin-walled tube phantom. Initial in vivo feasibility testing of the method was performed. The performance of the method was assessed through comparisons to images generated without skull corrections, with invasive source-based corrections, and with water-path control images. Results: For source locations at least 25 mm from the inner skull surface, the modified reconstruction algorithm successfully restored a single focus within the skull cavity at a location within 1.25 mm from the true position of the narrow-band source. The results obtained from imaging single bubbles are in good agreement with numerical simulations of point source emitters and the authors' previous experimental measurements using source-based skull corrections O'Reilly et al. [IEEE Trans. Biomed. Eng. 61, 1285-1294 (2014)]. In a rat model, microbubble activity was mapped through an intact human skull at pressure levels below and above the threshold for focused ultrasound-induced blood-brain barrier opening. During bursts that led to coherent bubble activity, the location of maximum intensity in images generated with CT-based skull corrections was found to deviate by less than 1 mm, on average, from the position obtained using source-based corrections. Conclusions: Taken together, these results demonstrate the feasibility of using the method to guide bubble-mediated ultrasound therapies in the brain. The technique may also have application in ultrasound-based cerebral angiography. [ABSTRACT FROM AUTHOR] more...

Purpose: Cranial distraction osteogenesis (DO) has many advantages for correcting skull deformities: Thus, DO is extensively used for the treatment of skull deformities. However, diverse, unexpected complications are associated with this procedure. In this study, we present the surgical outcomes and complications of DO. Moreover, we propose a modified protocol for DO to reduce complications. Methods: This is a retrospective study on managed patients that underwent DO between March 2008 and May 2013. Their clinical courses were reviewed. Distraction protocols were individually inspected, and the final surgical outcomes, including complications, were evaluated. Results: During the study period, a total of ten patients (seven boys and three girls) were treated at our institute. The median distraction period was 20.5 days (ranging from 17 to 50 days). The range of total distraction length was 19-22 mm. The median consolidation period was 96 days (ranging from 0 to 343 days). All patients achieved the goals of distraction. At follow-up evaluations, all patients, except one, showed good surgical outcomes in both head shape and neurologic symptoms. There were six patients with wound complications during the treatment period. Among them, the distractors were removed early in three patients. Interestingly, even these three patients, without a sufficient consolidation period, showed good outcomes. Conclusions: Although DO has many merits for correcting skull deformities, it frequently causes severe wound complications. To reduce these complications, we propose a modified protocol with a minimal or even no consolidation period. [ABSTRACT FROM AUTHOR] more...

Purpose: The shape and size of the foramen magnum (FM) can be altered in craniosynostoses. However, few studies have investigated these changes. In this paper, we investigate the morphology of the foramen magnum in syndromic and non-syndromic brachycephaly. Methods: Surface area, anteroposterior (AP) diameter, and transverse diameters of the FM were measured on high-resolution CT scans in children with Crouzon (25), Pfeiffer (21), Apert (26), Saethre-Chotzen (7) syndromes, and isolated bicoronal synostosis (9) and compared to an age-matched control group (30). Results: A significantly smaller FM surface area was observed in Crouzon (6.3 ± 1.7 cm) and Pfeiffer (6.4 ± 2.3 cm) syndromes as compared to the control group (7.4 ± 1.3 cm, p = 0.006 and p = .017, respectively). In comparison to the control group, no statistically significant alteration in FM surface area was noted in patients with Apert, Saethre-Chotzen, or isolated bicoronal synostosis ( p = 0.37, p = 0.71, p = 0.40 respectively). The transverse diameter of FM was significantly smaller in Crouzon, Pfeiffer, and Apert syndromes compared to the control group ( p = 0.005, p = 0.002, p = 0.03 respectively). In Saethre-Chotzen and isolated bicoronal synostosis, no difference in transverse diameter was demonstrated. Among all groups, only Crouzon syndrome showed reduced anteroposterior diameter as compared to controls ( p = 0.005). In Pfeiffer and Apert syndromes, there was elongation of the shape of the FM with a relatively narrowed width as demonstrated in a significantly increased AP to transverse diameter ratio ( p = 0.002 and p = 0.019, respectively). Discussion and conclusions: The FM shape and area is significantly altered in fibroblast growth factor receptor (FGFR)-related brachycephaly syndromes (Crouzon, Pfeiffer, and Apert), whereas in patients with Saethre-Chotzen syndrome (TWIST-1 mutation) and isolated non-syndromic bicoronal synostosis, the shape and mean FM area was not statistically different from that of normals. This study brings to light the important role of FGFRs on FM growth and shape. TWIST-1 mutation (Saethre-Chotzen syndrome) does not appear to have an important effect in shaping the FM. [ABSTRACT FROM AUTHOR] more...

Background: Most cancers in the head and neck region spread locally. This study was designed to evaluate the involvement of the cranium in cause of death among head and neck skin cancer patients. Methods: All cases of skin malignancy appearing in the head and neck region were documented. Cause of death was noted for all deceased head and neck skin cancer patients. Cranial involvement, or not, was recorded in each case. Recurrent lesions, types of previous treatment, if any, and cranial perforation, when present, were documented. Results: One hundred thirty-one patients were seen. One hundred eighteen (90.1 %) had lesions involving the cranium. Thirty-four head and neck cancer patients died during study period. Thirty-two (94.1 %) died as a result of local spread of disease to the brain through the cranium. Recurrent and persistent lesions were accounted for 35 (26.7 %) cases; out of which, 18 (13.7 %) had been excised and wound was immediately closed directly; 10 (7.6 %) had been excised and wound immediately primarily closed using vascularized free flaps. Five (3.8 %) had previously been managed solely with radiotherapy. Two (1.5 %) applied 5FU ointment on prescription for basal cell carcinoma, which transmuted to squamous cell carcinoma. Eleven (8.4 %) referral cases with cranial perforation presented after recurrence. Conclusions: Deaths that were caused by spread of cancer to the brain through the cranium were 94.1 %. Radiotherapists should be educated on the grave danger of causing osteoradionecrosis of the cranium. The value of medical remedies for malignancies around the cranium should be properly reevaluated. Surgery appears to be the favoured therapy for cranium-involved skin cancer. Level of Evidence: Level IV, risk / prognostic study [ABSTRACT FROM AUTHOR] more...

Spinal cord infarction is extremely rare in patients with giant cell arteritis (GCA). There are only four case reports in the literature. We describe a 65-year-old man who presented with sudden paraplegia and back pain of 4-days duration with sensory loss below the umbilicus and bilateral scalp necrosis. Magnetic resonance imaging finding was consistent with dorsal spinal cord infarction. Biopsy of the temporal artery confirmed the diagnosis of GCA. The patient was treated with high dose of corticosteroids, which resulted in healing of the scalp ulcerations in 3 weeks, but the paraplegia was irreversible. To our knowledge, this is the first report of spinal cord infarction and simultaneous occurrence of bilateral scalp necrosis in a histopathologically proven GCA. Although literature about spinal cord involvement in GCA is very limited, cord infarction is associated with high mortality and therapeutic challenges since little is understood regarding the pathogenesis that leads to infarction. [ABSTRACT FROM AUTHOR] more...

The development of a new generation of biomaterials with high osteogenic ability for fast osseointegration with host bone is being intensively investigated. In this study, we have fabricated three-dimensional (3-D) strontium-containing mesoporous bioactive glass (Sr-MBG) scaffolds by a 3-D printing technique. Sr-MBG scaffolds showed uniform interconnected macropores (∼400 μm), high porosity (∼70%) and enhanced compressive strength (8.67 ± 1.74 MPa). Using MBG scaffolds as a control, the biological properties of Sr-MBG scaffolds were evaluated by apatite-forming ability, adhesion, proliferation, alkaline phosphatase activity and osteogenic gene expression of osteoblast-like cells MC3T3-E1. Furthermore, Sr-MBG scaffolds were used to repair critical-sized rat calvarial defects. The results showed that Sr-MBG scaffolds possessed good apatite-forming ability and stimulated MC3T3-E1 cell proliferation and differentiation. Importantly, the in vivo results revealed that Sr-MBG scaffolds had good osteogenic capability and stimulated new blood vessel formation in critical-sized rat calvarial defects within 8 weeks. Therefore, 3-D printed Sr-MBG scaffolds with favorable pore structure and high osteogenic ability have more potential applications in bone regeneration. [ABSTRACT FROM AUTHOR] more...

Background: The authors describe their experience with the reconstruction of complex anterior skull base defects after trauma or tumour resection using a 'sandwich' technique with pericranial flap, titanium mesh and TachoSil. Methods: Description of surgical anatomy, surgical technique, indications, limitations, complications, specific perioperative considerations and specific information to give to the patient about surgery and potential risks. A summary of ten key points is given. Conclusions: After a bifrontal craniotomy and a subfrontal approach, it is possible to achieve a reliable reconstruction of the anterior skull base in a watertight manner by fixing a pericranial flap or a fascia lata graft to the orbital roofs and planum sphenoidale with an individually tailored titanium mesh and closing the frontobasal dura leasion with TachoSil. [ABSTRACT FROM AUTHOR] more...