Morphometric assessment methods for estimation of sexual dimorphism from cranial occipital condyles / Métodos de evaluación morfométrica para la estimación del dimorfismo sexual de los cóndilos occipitales craneales

SUMMARY: Identification of fragmentary human remains is an integral par of medico legal investigations. Occipital region is commonly not affected in traumatic injuries and accidents due to its secluded position which makes it the integral part in determination of sex in the absence of entire skeleton. Occipital condylar region is also the most common area for degenerative and neoplastic diseases. So thorough knowledge of anatomy of occipital condyle is very essential during surgical interventions. 86 skulls were studied from osteological collections of Department of Anatomy, Yenepoya Medical College. Maximum length and breadth of the occipital condyle, anterior intercondylar distance and posterior intercondylar distance was measured with the help of vernier callipers. Descriptive statistics was calculated for the parameters considered. Metric data of right and left sides were compared with student t test and p value was calculated.All data obtained was subjected for discriminant function analysis to derive the statistical model. All the measurements were significantly high in males compared to females. Condylar length and width, anterior and posterior intercondylar distance can be used to derive formula for determination of sex in south Indian population with an accuracy of 66.3 %.

RESUMEN: La identificación de restos humanos fragmentarios es una parte integral de las investigaciones médico legales. La región occipital comúnmente no se ve afectada en lesiones traumáticas y accidentes debido a su posición apartada que la convierte en parte integral en la determinación del sexo en ausencia de un esqueleto completo. La región condilar occipital es también el área más común de enfermedades degenerativas y neoplásicas. Por lo tanto, el conocimiento integral de la anatomía del cóndilo occipital es esencial durante las intervenciones quirúrgicas. Se estudiaron 86 cráneos de colecciones osteológicas del Departamento de Anatomía, Facultad de Medicina de Yenepoya. Se midió el largo y ancho máximo del cóndilo occipital, la distancia intercondilar anterior y la distancia intercondilar posterior con la ayuda de un calibrador vernier. Se calculó la estadística descriptiva para los parámetros considerados. Los datos métricos de los lados derecho e izquierdo se compararon con la prueba t de Student y se calculó el valor de p. Todos los datos obtenidos se sometieron a análisis de función discriminante para derivar el modelo estadístico. Todas las medidas fueron significativamente altas en los hombres en comparación con las mujeres. La longitud y el ancho del cóndilo, la distancia intercondilar anterior y posterior se pueden utilizar para derivar la fórmula para determinar el sexo en la población del sur de la India con una precisión del 66,3 %.

Frequency of enlarged external occipital protuberance and its association with age and sex: a cross-sectional CT scan study / Frecuencia de la protuberancia occipital externa agrandada y su asociación con la edad y el sexo: un estudio de tomografía computarizada transversal

SUMMARY: External occipital protuberance (EOP) is a midline bony protrusion in the occipital bone, the significance of which has gained recent attention in the medical community. Our present study aims to assess the average size of EOP in a Jordanian cohort and its relation to age and sex, while determining the frequency of enlarged EOP in this cohort. The present study was a cross-sectional study that was carried out in a referral hospital in Jordan. We reviewed thousands of CT scans taken with dedicated bone window imaging during the last two years, beginning January 2018. Measurements were taken by trained radiology residents and were then further reviewed by radiology specialists. An EOP was classified as enlarged (EEOP) if it exceeded 10 mm. A total of 4409 patients, 2265 (51.4 %) females and 2144 (48.6 %) males, met our inclusion criteria. Their mean age was 54.1 ? 22.2 years. The mean size of the EOP in these patients was 8.4 ? 4.2 mm (range: 0-56 mm). Out of the 4409-study population, 1210 (27.4 %) presented with EEOP. The prevalence of an EEOP was significantly higher in the male population (33.6 %) when compared with the female population (21.6 %) (P < 0.001). The size of the EOP was also significantly related to the age of the patient, with EEOP increasing with increasing age. The mean size of EOP in our Jordanian cohort was 8.4 ? 4.2 mm. The frequency of enlarged EOP was found to be 27.4 % in our cohort, and was significantly more common in males and in older patients.

RESUMEN: La protuberancia occipital externa (POE) es una protuberancia ósea localizada en el plano mediano del hueso occipital, cuya importancia recientemente ha ganado atención en la comunidad médica. Este estudio tuvo como objetivo evaluar el tamaño promedio de POE en una cohorte jordana y su relación con la edad y sexo, mientras se determina la frecuencia de POE aumentada en este grupo. Se llevó a cabo un estudio transversal en un hospital de referencia en Jordania. Revisamos miles de imagenes radiológicas en tomografía computarizada y visualización de ventanas durante los últimos dos años, a partir de enero de 2018. Las mediciones fueron tomadas por residentes de radiología, y luego revisadas por especialistas en radiología. Un POE se clasificó como aumentado (POEA) si superaba los 10 mm. Un total de 4409 pacientes, 2265 (51,4 %) mujeres y 2144 (48,6 %) hombres, cumplieron con nuestros criterios de inclusión. La edad media fue de 54,1 ? 22,2 años. El tamaño medio del POE en estos pacientes fue de 8,4 ? 4,2 mm (rango: 0-56 mm). De la población del estudio 4409, 1210 (27,4 %) presentaron POEA. La prevalencia de una POEA fue significativamente mayor en la población masculina (33,6 %) en comparación con la población femenina (21,6 %) (P <0,001). El tamaño del POE también se relacionó significativamente con la edad del paciente, aumentando el POEA con la edad. El tamaño medio de POE en nuestra cohorte jordana fue de 8,4 ? 4,2 mm. Se encontró que la frecuencia de aumento de POE en nuestra cohorte fue del 27,4 % y fue significativamente más común en hombres y en pacientes mayores.

Observational study of patients with occipital condyle fracture at a brazilian referral trauma center / Estudo observacional de pacientes com fratura de côndilo ocipital em centro de referência em trauma no brasil

ABSTRACT Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. Methods: this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. Results: a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was the main determinant for negative outcomes. Conclusion: the findings of this study are in accordance with available literature data. The use of external stabilization with a cervical collar is reinforced for the treatment of stable lesions, even when these are bilateral. Assessment of the patients' follow-up results in the studied sample may contribute with useful information for the treatment of occipital condyle fractures.

RESUMO Objetivo: avaliar o perfil clínico-epidemiológico, o tratamento e a evolução de pacientes com fraturas do côndilo occipital (FCO) em um dos maiores centros especializados em trauma na América Latina. Método: este é um estudo observacional retrospectivo de FCO identificadas em casos de trauma que foram atendidos no período de Dezembro de 2011 a Dezembro de 2019 pela equipe de trauma de centro de trauma Tipo 3. Resultados: um total de vinte e oito fraturas do côndilo occipital foram identificadas em 26 pacientes. A incidência foi inferior a 0.2% ao ano e mais comum em pacientes do sexo masculino (proporção 4:1) envolvidos em acidentes de trânsito. A idade média foi de 42.08 anos. O Tipo II de Anderson e Montesano e o Tipo 1 de Tuli foram os mais frequentes (67.9% e 89.3%, respectivamente) e nenhum caso teve instabilidades C0C1C2. Todos os pacientes foram tratados com colar cervical por período de 3 a 6 meses. Cerca de 65% dos pacientes apresentaram boa evolução (Escala de Resultados de Glasgow maior ou igual a 4), e a gravidade da lesão cerebral foi o principal determinante para os resultados negativos. Conclusão: os achados deste estudo são similares a dados disponíveis na literatura. O uso de colar cervical para estabilização externa é reforçado para o tratamento de lesões estáveis, mesmo quando bilaterais. A avaliação dos resultados do acompanhamento dos pacientes na amostra estudada pode contribuir com informações úteis para o tratamento de fraturas de côndilo occipital.

Giant Cell Reparative Granuloma in the Temporal Bone of a 4-Month-Old Infant / 대한이비인후과학회지

Giant cell reparative granuloma (GCRG) is a rare benign bone disease of unknown causes. Trauma is a suspected cause or contributor to the onset of GCRG, of which only a few cases have been reported worldwide. We report a case of temporal bone GCRG in a 4-month-old male newborn, who was born at full term via spontaneous vaginal delivery with recent presentation of right facial palsy. He had a right temporo-occipital craniectomy due to GCRG 1 month earlier. There had been no history of trauma. During the workup of the facial palsy complaint, we identified a lobulated mass in the right temporal bone by computed tomography and magnetic resonance imaging. The mass was mainly in the petrous portion of the temporal bone with extracranial extension through the occipital bone. This was consistent with a GCRG recurrence. The mass was removed via the transcrusal approach, and the final histopathology report confirmed it as recurrent GCRG.

Feasibility and Effectiveness of Direct Puncture and Onyx Embolization for Transverse Sinus Dural Arteriovenous Fistula

Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.

Arachnoid Granulations Mimicking Multiple Osteolytic Bone Lesions in the Occipital Bone

We report a rare case of arachnoid granulations mimicking multiple osteolytic bone lesions. A 66-year-old woman was admitted to a local clinic for a regular checkup. Upon admission, brain CT showed multiple osteolytic lesions in the occipital bone. These needed to be differentiated from multiple osteolytic bone tumor. Subsequent brain MRI revealed that the osteolytic lesions were isointense to cerebrospinal fluid, hyperintense on T2-weighted image, hypointense on T1-weighted image, and with subtle capsules around the osteolytic lesions that were visible after gadolinium injection. A bone scan revealed no radiotracer uptake. The lesions were in both the transverse sinuses and the torcular herophili. With typical radiological appearances of the lesions, the osteolytic lesions were diagnosed as multiple arachnoid granulations. No further treatment was planned. A 1-year follow-up brain CT scan revealed no change. We should consider the possibility of arachnoid granulations when multiple osteolytic lesions are observed in the occipital bone.

Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note

OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required.METHODS: A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery.RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading.CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

Efetividade do protocolo para prevenção de lesões por pressão implantado em Unidade de Terapia Intensiva / Effectivenesses of protocol impremented in an intensive Care Unit for the prevention of pressure ulcers

Este estudo objetivou avaliar efetividade da implantação do protocolo para prevenção de lesão por pressão em unidade de terapia intensiva. Estudo quantitativo descritivo, analítico e documental. Foram aplicados testes Qui-quadrado de Pearson, Exato de Fisher para variáveis categóricas e Mann-Whitney para numéricas; significância de 5% e intervalo de confiança de 95%. A Amostra totalizou 566 pacientes, com médias de idade de 45 anos, escore da escala de Braden de 12,4 e tempo de internamento de 9,8 dias. Predominaram lesão por pressão sacral na admissão (11,1%); do sexo masculino (66,9%) e procedência da emergência (54,0%). Houve redução significativa de lesão por pressão durante o internamento (36,6% para 12,3%), da média do tempo de internamento (11,4 para 7,1 dias), bem como o surgimento de lesão por pressão em regiões calcânea (25,7% para 3,7%) e sacra (9,9% para 2,8%). Foi comprovada a efetividade da implantação do protocolo para prevenção de lesão por pressão.

Congenital Cholesteatoma of Mastoid Temporal Bone and Posterior Cranial Fossa Treated with Transmastoid Marsupialization / 대한이비인후과학회지

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.

Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note

OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. METHODS: A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery. RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

Direct Intraoperative Reduction of Basilar Invagination Associated with Atlantoaxial Subluxation ­ Technical Note

In the present article, we describe a technique of direct intraoperative reduction of congenital atlantoaxial subluxation associated with severe basilar invagination and atlas assimilation. It consists of a wide dissection of the craniovertebral junction, exposing the region between the superior facet of C2 and the occiput (described as a "pseudoarticulation" by some authors). After exposure, a self-rotating small dissector or Kobe is used bilaterally, pushing C2 anteriorly and inferiorly, with reduction of the dislocation, followed by craniovertebral fixation. The technique is safe and eliminates the need for an anterior approach to the odontoid reduction, as well as the need to dissect the C1­2 joint.

Neste artigo, descrevemos a técnica de redução intraoperatória direta de subluxação atlantoaxial congênita associada a invaginação basilar grave e assimilação do atlas. Ela consiste em ampla dissecção da junção craniovertebral, expondo a região entre a face superior da C2 e o osso occipital (descrita como uma "pseudoarticulação" por alguns autores). Após exposição, um descolador pequeno ou Kobe é usado bilateralmente com rotação própria, deslocando C2 anterior e inferiormente, com redução da luxação, seguido de fixação craniovertebral. A técnica é segura e elimina a necessidade de uma abordagem anterior para a ressecção do odontoide, além de evitar a dissecação da junta C1­C2.

C1-C4 Dorsal Column Stimulation for Refractory Occipital Neuralgia Treatment. Case Report

Introduction Refractory occipital neuralgia is a difficult medical condition, especially when the patient has already been submitted to occipital nerve neurectomy and radiofrequency rhizotomy. There is no case report of spinal cord stimulation in the C1- C4 cervical segments for this condition. Objective To evaluate if C1-C4 dorsal spinal cord stimulation is effective in a patient with refractory occipital neuralgia who was already submitted to neurectomy and rhizotomy. Methods After obtaining the approval from the Ethics Committee of one of our institutions, a unilateral laminectomy was performed between C3 and C4, and a neurostimulator lead was conducted until the posterior portion of the C1 arc was in full view. Then we performed an intraoperative test to evaluate the correspondence between pain location and stimulation-induced paresthesias. We could not put the subcutaneous lead for such condition because of the scar tissue of the area and the previous neurectomy. Results After one year of follow up, we noticed a dramatic improvement in pain control, as well as medication withdrawal. The score of the visual analogue scale was 9 before the surgery, and it dropped to 2 after 1 year of follow-up. Conclusion Spinal cord stimulation between the C1 and C4 cervical segments can be an option for selected cases of refractory occipital neuralgia, including those patients who have already been submitted to neurectomy or rhizotomy.

Neuralgia occipital refratária é uma condição médica difícil, especialmente em pacientes submetidos previamente a neurectomia nos nervos occipitais e rizotomia por radiofrequência. Não há na literatura relato de estimulação da medula espinhal entre os níveis C1 e C4 para essa condição. Objetivos Avaliar se a estimulação da coluna dorsal da medula nos níveis C1 a C4 é eficaz no controle da dor em paciente com neuralgia occipital refratária já submetido a neurectomia e rizotomia. Métodos Após aprovação do Conselho de Ética de uma de nossas instituições, foi realizada laminectomia unilateral de C3 e C4, com posterior introdução do conjunto de eletrodos em placa, que foi posicionado até que a porção anterior do arco de C1 estivesse sob visão direta. Posteriormente, foi realizado um teste intraoperatório para avaliar a correspondência entre a área dolorosa e a parestesia induzida pela estimulação. Não possível optar pelo uso de eletrodo subcutâneo devido ao extenso tecido cicatricial secundário às cirurgias prévias. Resultados Melhora significativa da dor ocorreu ao longo de um ano de acompanhamento, com redução progressiva da dose da medicação. O valor da escala visual analógica no pré-operatório era 9, e após 1 ano de acompanhamento, reduziu para 2. Conclusão Estimulação da coluna dorsal da medula espinhal entre os seguimentos C1 e C4 pode, em casos selecionados, ser uma opção terapêutica na neuralgia occipital refratária, incluindo pacientes que já foram submetidos a neurectomia e rizotomia.

Morphological Analysis on the Occipital Condyles and Review of the Literature / Análisis Morfológico de los Cóndilos Occipitales y Revisión de la Literatura

Most anatomical and biomechanical studies on the craniovertebral junction have involved morphological or morphometric analysis on the occipital condyles. Some of these studies have provided important findings based on different surgical procedures. The shape, size and angle of the occipital condyles and the locations of the intracranial and extracranial orifices of the hypoglossal canal are highly important because they may affect the lateral approaches to the craniovertebral junction. To determine the frequency of occurrence of different morphological types of occipital condyle. 214 occipital condyles in 107 dry human skulls were analyzed and the classification of their morphological types was determined through assessing digitized photographic images. Among the 107 skulls analyzed, 59.8 % were male and 40.2 % were female. Their ages ranged from 11 to 91 years, with a mean of 57.56 years. Of the total of 10 morphological types of occipital condyle that were found, more than 50 % were of the "8", "S" and ring types. Condyles of "8" and "S" shape were the main types found in male skulls: the "8" shape prevailed on the left side and the "S" shape on the right side. However, in female skulls, these two types had equal bilateral distribution.

La mayor parte de los estudios anatómicos y biomecánicos de la unión cráneo-vertebral han sido realizados sobre el análisis morfológico o de la morfometría de los cóndilos occipitales. Algunos de estos trabajos tienen previsto importantes hallazgos basados en diferentes procedimientos quirúrgicos. De tal forma, el tamaño y ángulo del cóndilo occipital bien como su localización de los orificios intracraneales y extracraneales del canal hipogloso son de gran importancia, ya que pueden afectar a los enfoques laterales de la unión cráneo-vertebral. El objetivo del estudio fue determinar la prevalencia de los tipos morfológicos de cóndilos occipitales. Fueron analizados 214 cóndilos de 107 cráneos secos de humanos y la clasificación de los tipos morfológicos fue determinada a partir de los análisis de estudio de imágenes fotográficas digitalizadas. De los 107 cráneos que fueron analizados, 59,8 % eran de sexo masculino y 40,2 % de sexo femenino, cuyas edades comprendidas entre 11 y 91 años con una media de 57.56 años. De un total de 10 tipos morfológicos de los cóndilos occipitales encontrados, más del 50 % eran de tipo ocho, S y anillo. Los cóndilos en forma de "8" y "S" fueron los principales tipos encontrados, en el sexo masculino, la forma en "8" prevaleció en el lado izquierdo, y el tipo morfológico en "S", en el lado derecho del cráneo. Mientras que en el sexo femenino esos dos tipos tuvieron una equitativa distribución bilateral.

Posterior occipito cervical decompression with fixation [ and fusion in Cranio vertebral junction compression

Objective: To find out the clinical outcome of posterior decompression with occipitocervical fixation ani fusion in patients with Craniovertebral junction instability

Methods: Eighty consecutive patients of cranio vertebral junction [CVJ] compression were treated the department of neurosurgery, Jinnah Postgraduate Medical Centre [JPMC], Karachi over a periodol 05 years from 1st January 2012 till 31st August 2016. All patients underwent posterior decompression witty occipitocervical fusion [OCF] and fixation. The clinical outcome was assessed by Japanese Orthopedic Association [JOA] score and grading

Results: Out of 80 patients with CVJ instability, 64 [80%] were due to non traumatic causes, while II [20%] were secondary to trauma. All 80 patients [100%] showed post operative relief in pain. Sixty to [80%] patients showed improvement in power post operatively while six [7.5%] had no change, four [51] showed deterioration and six [7.5%] patients expired. Sixty four [80%] patients had improvement of the J01 scores at last follow-up. According to etiology, the JOA score for patients with trauma improved in 12[7S] patients and 52[81.25%] for non traumatic causes while six patients [7.5%] expired. Fusion was achieved 64 [80%] patients at last followup

Conclusion: Posterior decompression with occipitocervical fusion and fixation is safe and can be recommended in cases of CVJ compression

Retrospective analysis of a case series of patients with traumatic injuries to the craniocervical junction / Análise retrospectiva de série de casos com lesões traumáticas da junção craniocervical

ABSTRACT Objective To evaluate the correlation between the treatment, the characteristics of the lesions and the clinical outcome of patients with traumatic injuries to the craniocervical junction. Methods This was a retrospective study of patients treated conservatively or surgically between 2010 and 2013 with complete data sets. Results We analyzed 37 patients, 73% were men with mean age of 41.7 years. Of these, 32% were submitted to initial surgical treatment and 68% received conservative treatment. Seven (29%) underwent surgery subsequently. In the surgical group, there were seven cases of odontoid type II fractures, two cases of fracture of posterior elements of the axis, one case of C1-C2 dislocation with associated fractured C2, one case of occipitocervical dislocation, and one case of combined C1 and C2 fractures, and facet dislocation. Only one patient had neurological déficit that improved after treatment. Two surgical complications were seen: a liquoric fistula and one surgical wound infection (reaproached). In the group treated conservatively, odontoid fractures (eight cases) and fractures of the posterior elements of C2 (five cases) were more frequent. In two cases, in addition to the injuries of the craniocervical junction, there were fractures in other segments of the spine. None of the patients who underwent conservative treatment presented neurological deterioration. Conclusion Although injuries of craniocervical junction are relatively rare, they usually involve fractures of the odontoid and the posterior elements of the axis. Our results recommend early surgical treatment for type II odontoid fractures and ligament injuries, the conservative treatment for other injuries.

RESUMO Objetivo Avaliar a correlação entre o tratamento, as características das lesões e o resultado clínico em pacientes com lesões traumáticas na junção craniocervical. Métodos Estudo retrospectivo de pacientes maiores de 18 anos tratados de forma conservadora ou cirúrgica, entre 2010 e 2013. Resultados Foram analisados 37 pacientes, 73% eram do sexo masculino e a média de idade foi de 41,7 anos. Inicialmente 32% dos pacientes foram submetidos a tratamento cirúrgico, e 68% foram submetidos a tratamento conservador. Sete pacientes (29%) do grupo conservador foram submetidos posteriormente à cirurgia. No grupo cirúrgico, houve sete casos de fratura de odontóide tipo II, dois casos de fratura de elementos posteriores do áxis, um caso de luxação C1-C2, um caso de deslocamento occipito-cervical e um caso de fraturas de C1 e C2 e luxação facetária. Um paciente apresentava déficit neurológico, melhorando após o tratamento. Houve duas complicações pós-cirúrgicas, uma fístula liquórica e uma infecção de ferida operatória (reabordada). No grupo conservador, predominaram as fraturas do odontóide (oito) e dos elementos posteriores de C2 (cinco). Em dois casos, havia também fraturas em outros segmentos da coluna. Nenhum dos pacientes deste grupo apresentou deterioração neurológica. Conclusão As lesões da junção craniocervical são raras, sendo mais frequentes as fraturas do odontóide e dos elementos posteriores do áxis. Nossos resultados recomendam o tratamento cirúrgico precoce para os pacientes com fraturas do odontóide tipo II e lesões ligamentares, e tratamento conservador para os demais pacientes.

Odontoid process hypoplasia and bipartite atlas associated with atlanto-axial instability / Hipoplasia do processo odontóide e atlas bipartido associado a instabilidade atlanto-axial / Hipoplasia de la apófisis odontoide y atlas bipartito asociado con inestabilidad atlantoaxial

ABSTRACT Surgical treatment of craniocervical junction pathology has evolved considerably in recent years with the implementation of short fixation techniques rather than long occipito-cervical fixation (sub-axial). It is often difficult and sometimes misleading to determine the particular bone and vascular features (high riding vertebral artery, for instance) using only the conventional images in three orthogonal planes (axial, sagittal and coronal). The authors describe a rare clinical case of congenital malformation of the craniovertebral junction consisting of hypoplasia/agenesis of the odontoid process and bipartite atlas associated with atlantoaxial instability which was diagnosed late in life in a patient with a previous history of rheumatologic disease. The authors refer to the diagnostic process, including new imaging techniques, and three-dimensional multiplanar reconstruction. The authors also discuss the surgical technique and possible alternatives.

RESUMO O tratamento cirúrgico da patologia da charneira crânio-cervical tem evoluído consideravelmente nos últimos anos com a implementação de técnicas de fixação curta em detrimento de longas fixações occipito-cervicais (sub-axiais). Frequentemente é difícil e por vezes enganador determinar as variações ósseas e vasculares (artéria vertebral high-riding p.e.) apenas pelas imagens convencionais em três planos ortogonais (axial, sagital e coronal). Os autores descrevem um caso clínico raro de malformação congénita da charneira crânio-cervical constituída por hipoplasia/agenésia da odontoide e atlas bipartido, associado a instabilidade atlanto-axial e diagnosticado tardiamente em doente com antecedentes reumáticos prévios. Descreve-se o processo diagnóstico, incluindo novas técnicas de imagiologia e de reconstrução multiplanar tridimensional. Discute-se a técnica cirúrgica utilizada e possíveis alternativas.

RESUMEN El tratamiento quirúrgico de la patología de la región craneocervical ha evolucionado considerablemente en los últimos años con la aplicación de técnicas de fijación cortas en lugar de fijación occipito-cervical larga (sub-axial). A menudo es difícil y hasta engañoso determinar las características óseos y vasculares (arteria vertebral high-riding, por ejemplo) usando sólo imágenes convencionales en tres planos ortogonales (axial, sagital y coronal). Los autores describen un caso clínico poco frecuente de malformación congénita de la unión craneocervical que consiste en la hipoplasia/agenesia de la apófisis odontoides y atlas bipartito, asociado con la inestabilidad atlantoaxial, diagnosticado tardiamente en pacientes con enfermedades reumatológicas previas. Los autores relatan el proceso de diagnóstico, incluyendo nuevas técnicas de imagen y la reconstrucción multiplanar tridimensional. Los autores también discuten la técnica quirúrgica y las posibles alternativas.

Colocación endoscópica por vía occipital de catéteres ventriculares permanentes: nota técnica / Endoscopic access to occipital lateral ventricle using permanent catheters: technical note

El siguiente trabajo constituye una nota técnica sobre un nuevo proceder endoscópico de colocación de catéteres ventriculares permanente a través del cuerno occipital. Se colocaron 20 catéteres permanentes utilizando el sistema DECK con un endoscopio Hopkins II de 30°, diámetro 2,7 mm y longitud 30 cm, con vainas y canales de trabajos. La posición del catéter fue evaluada por tomografía de cráneo realizada a las 24 horas de la cirugía, obteniéndose una posición a (óptima) en el 95 por ciento de los casos, con una distancia promedio de 10,5 cm desde la tabla externa del hueso occipital al cuerno frontal. En ninguno de los casos disfuncionó el sistema derivativo y un solo paciente presentó como complicación un hematoma del lecho quirúrgico.

The following papers is a technical note about a new endoscopic access to lateral ventricle through occipital horn to place ventricles catheters, 20 patient was operated using Deck System of endoscopy with lens of 30 grades, 2,7 mm of diameter and 30 cm of larger, sheets and working canals including. CT scan was performing 24 hours after surgery and optimal position was obtained in 95 percent. Median distance from occipital bon to frontal horn of the ventricles was 10,5 cm. Any patient present dysfunction of the system and only one patient had a hematoma of the surgical area.

A Spontaneous Pneumatocele Presenting with External Auditory Canal Obstruction / 대한이비인후과학회지

A pneumatocele is an air-filled cavity in the body. In the head and neck areas, the extensive hyperpneumatization of the temporal and occipital bones is typically associated with pneumatocele formation, which results in the spontaneous collection of gas, usually air, beneath the pericranium or within the skull. We herein report a case of stenosis of the external auditory canal caused by a left mastoid pneumatocele in a 12-year-old boy who was successfully treated with left simple mastoidectomy and canaloplasty.

Central Skull Base Osteomyelitis: 10-Case Series in a Single Center / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Skull base osteomyelitis (SBO) typically evolves as a complication of malignant otitis externa (MOE) in diabetic patients and involves the temporal bone. Central SBO (CSBO), which mainly involves the sphenoid or occipital bones, has clinicaland radiological characteristics similar to those of SBO but without coexisting MOE. We investigated a group of patients with CSBO and studied the clinical course of CSBO. SUBJECTS AND METHOD: Medical records of patients who were diagnosed with CSBO were retrospectively analyzed from 1999 to 2014. RESULTS: Ten patients (mean age; 60.5 years) were identified. There were five males and five females. All patients suffered from headache, and six patients had cranial nerve palsy including oculomotor (20%), abducens (10%), vestibulocochlear (10%), glossopharyngeal (20%), vagus (30%) and hypoglossal (10%) nerve. Patients had underlying diseases including diabetes mellitus (40%), immunosuppression status after liver transplantation (10%) and cardiovascular disease (40%). Four patients received endoscopic biopsy and debridement for diagnostic and curative intent. Patients were treated with intravenous antibiotics for 5.1 weeks in average and oral antibiotics for 17 weeks. Mean follow-up period was 12.4 months and the mortality rate was zero. 40% of patients had residual neurologic deficit. The earliest sign of improving CSBO was headache (mean; 3.1 weeks) and the erythrocyte sedimentation rate was the latest improving sign (mean; 4 months). CONCLUSION: CSBO was diagnostic and therapeutic challenge to the clinicians. The timely diagnosis and long-term antibiotics therapy could avoid a mortality case and minimize the permanent neurologic deficit.