Angle Evaluation of Possible Routes that Can Be Used to Reach the Foramen Ovale in the Anterior Approach / Evaluación Angular de Posibles Rutas que se Pueden Utilizar para Alcanzar el Foramen Oval en el Abordaje Anterior

SUMMARY: For the treatment of trigeminal neuralgia, the foramen ovale is reached by entering the cheek with a needle. Thermocoagulation is performed with balloon compression, administration of alcohol or radiofrequency. Apart from the classical method, it is theoretically possible to reach the foramen ovale through the mouth with the anterior approach. In our study, it was aimed to examine horizontally and vertically the angular values that must be given to the needle to reach the foramen ovale in the anterior approach. Three landmark points were determined on both right and left sides of 25 dry skulls. A rod was inserted starting from these landmark points and passing through the center of the foramen ovale. The vertical and horizontal angular values of this bar were measured. For each foramen ovale, 3 vertical angles, 3 horizontal angles and 4 distance measurements were made. There was a significant difference between the right and left sides in terms of horizontal angular values. Average values of horizontal angles (in degrees); on the right, 7.29 for H1, 12.15 for H2, 32.29 for H3; 1.26 for H1, 9.46 for H2, and 30.56 for H3 on the left side (p<0.005). The angle value was measured as 0 or negative value in 5 (20 %) of the H1 angle measurements made on the right side and 14 (56 %) on the left side. The H2 angle value was found to be smaller than the H1 angle in the skull 2 (8 %) on the right and 3 (12 %) on the left. There was no difference between the right and left sides in terms of vertical angular values. A significant difference was found between the right and left sides in the D1, D2, D4 distances (p<0.005). Six important anatomical features affecting angular values were encountered.

Para el tratamiento de la neuralgia del trigémino, se alcanza el foramen oval introduciendo una aguja en la mejilla. La termocoagulación se realiza con compresión con balón, administración de alcohol o radiofrecuencia. Aparte del método clásico, en teoría es posible alcanzar el foramen oval a través de la cavidad oral mediante el abordaje anterior. En nuestro estudio se tuvo como objetivo examinar horizontal y verticalmente los valores angulares que se deben dar a la aguja para alcanzar el foramen oval en el abordaje anterior. Se determinaron tres puntos de referencia en los lados derecho e izquierdo de 25 cráneos secos. Se insertó una varilla comenzando desde estos puntos de referencia y pasando por el centro del foramen oval. Se midieron los valores angulares verticales y horizontales de esta barra. Para cada foramen oval se realizaron mediciones de 3 ángulos verticales, 3 ángulos horizontales y 4 distancias. Hubo una diferencia significativa entre los lados derecho e izquierdo en términos de valores angulares horizontales. Valores medios de ángulos horizontales (en grados); a la derecha, 7,29 para H1, 12,15 para H2, 32,29 para H3; 1,26 para H1, 9,46 para H2 y 30,56 para H3 en el lado izquierdo (p<0,005). El valor del ángulo se midió como 0 o valor negativo en 5 (20 %) de las mediciones del ángulo H1 realizadas en el lado derecho y 14 (56 %) en el lado izquierdo. Se encontró que el valor del ángulo H2 era menor que el ángulo H1 en el cráneo 2 (8 %) a la derecha y 3 (12 %) a la izquierda. No hubo diferencia entre los lados derecho e izquierdo en términos de valores angulares verticales. Se encontró diferencia significativa entre el lado derecho e izquierdo en las distancias D1, D2, D4 (p<0,005). Se encontraron seis características anatómicas importantes que afectan los valores angulares.

Crista Galli Morphometry and Morphology: An Anatomical, Radiological, and Machine Learning Application Study / Crista Galli Morfometría y Morfología: Un Estudio de Aplicación Anatómica, Radiológica y de Aprendizaje Automático

SUMMARY: The study purposed to examine the morphometry and morphology of crista galli in cone beam computed tomography (CBCT) and apply a new analysis, supervised Machine Learning techniques to find the answers to research questions "Can sex be determined with crista galli morphometric measurements?" or "How effective are the crista galli morphometric measurements in determining sex?". Crista galli dimensions including anteroposterior, superoinferior, and laterolateral were measured and carried out on 200 healthy adult subjects (98 females; 102 males) aged between 18-79 years. Also, crista galli was classified with two methods called morphological types and Keros classification. In this study, the Chi-square test, Student's t-test, and Oneway ANOVA were performed. Additionally, Machine Learning techniques were applied. The means of the CGH, CGW, and CGL were found as 14.96 mm; 3.96 mm, and 12.76 mm in males, respectively. The same values were as 13.54 mm; 3.51 mm and 11.59±1.61 mm in females, respectively. The CG morphometric measurements of males were higher than those of females. There was a significant difference between sexes in terms of morphological classification type. Also, when the sex assignment of JRip was analyzed, out of 102 male instances 62 of them were correctly predicted, and for 98 female instances, 70 of them were correctly predicted according to their CG measurements. The JRip found the following classification rule for the given dataset: "if CGH<=14.4 then sex is female, otherwise sex is male". The accuracy of this rule is not high, but it gives an idea about the relationship between CG measurements and sex. Although the issue that CG morphometric measurements can be used in sex determination is still controversial, it was concluded in the analysis that CG morphometric measurements can be used in sex determination. Also, Machine Learning Techniques give an idea about the relationship between CG measurements and sex.

En el estudio se propuso examinar la morfometría y la morfología de la crista galli del hueso etmoides usando tomografía computarizada de haz cónico (CBCT) y aplicar un nuevo análisis, técnicas de aprendizaje automático supervisado para encontrar las respuestas a las preguntas de investigación "¿Se puede determinar el sexo con mediciones morfométricas de la crista galli?" o "¿Qué tan efectivas son las medidas morfométricas de la crista galli para determinar el sexo?". Las dimensiones de la crista galli, incluidas los diámetros anteroposterior, superoinferior y laterolateral, se midieron y realizaron en 200 sujetos adultos sanos (98 mujeres; 102 hombres) con edades comprendidas entre los 18 y los 79 años. La crista galli se clasificó con dos métodos llamados tipos morfológicos y clasificación de Keros. En este estudio, se realizaron la prueba de Chicuadrado, la prueba t de Student y ANOVA de una vía. Adicionalmente, se aplicaron técnicas de Machine Learning. Las medias de CGH, CGW y CGL se encontraron en 14,96 mm; 3,96 mm y 12,76 mm en hombres, respectivamente. Los mismos valores fueron 13,54 mm; 3,51 mm y 11,59 ± 1,61 mm en mujeres, respectivamente. Las medidas morfométricas del CG de los hombress fueron más altas que las de las mujeres. Hubo una diferencia significativa entre sexos en cuanto al tipo de clasificación morfológica. Además, cuando se analizó la asignación de sexo de JRip, de 102 instancias masculinas, 62 de ellas se predijeron correctamente, y de 98 instancias femeninas, 70 de ellas se predijeron correctamente de acuerdo con las mediciones de CG. El JRip encontró la siguiente regla de clasificación para el conjunto de datos dado: "si CGH<=14.4, por tanto el sexo es femenino, de lo contrario, el sexo es masculino". La precisión de esta regla no es alta, pero da una idea de la relación entre las medidas del CG y el sexo. Aunque la pregunta si las medidas morfométricas CG se pueden usar en la determinación del sexo sigue aún siendo controvertida. Se concluyó en el análisis que las medidas morfométricas CG se pueden usar en la determinación del sexo. Además, las técnicas de aprendizaje automático dan una idea de la relación entre las medidas de CG y el sexo.

mRNA expression of myosin heavy chain isoforms in the sphenomandibularis portion of the temporalis muscle / Expresión de ARNm de las isoformas de la cadena pesada de la miosina en la porción esfenomandibular del músculo temporal

SUMMARY: The main objective of this study was to analyze by real-time quantitative polymerase chain reaction (RT-qPCR) the expression patterns of the myosin heavy chain (MHC) isoforms (MHC-I, MHC-IIa, MHC-IIx) in the sphenomandibularis portion of the temporalis muscle. We expected to find differences between the sphenomandibularis and the other portions of the temporalis that could be related to the functional characteristics of the sphenomandibularis identified by electromyography. We dissected the right temporalis muscle of ten adult human individuals (five men and five women). Samples of the anterior and posterior temporalis and of the sphenomandibularis portion were obtained from each dissected muscle. These samples were analyzed by RT-qPCR to determine the percentages of expression of the MHC-I, MHC-IIa and MHC-IIx isoforms. No significant differences were identified between the anterior and the posterior temporalis in the expression patterns of the MHC-I, MHC-IIa and MHC-IIx isoforms. However, there were significant differences between the sphenomandibularis and the anterior temporalis. Specifically, the sphenomandibularis portion had a higher percentage of expression of the MHC-I isoform (P=0.04) and a lower percentage of expression of the MHC-IIx isoform (P=0.003). The pattern of expression that we observed in the sphenomandibularis reflects a greater resistance to fatigue, a lower contraction speed, and a lower capacity of force generation in the sphenomandibularis compared to the anterior temporalis. These characteristics are consistent with electromyographic findings on the functional differences between these two portions.

RESUMEN: El principal objetivo de este estudio fue analizar mediante real-time quantitative polymerase chain reaction (RT-qPCR) los patrones de expresión de las isoformas de la cadena pesada de la miosina (MHC-I, MHC-IIa y MHC-IIx) en la porción esfenomandibular del músculo temporal. Se esperó encontrar diferencias entre el esfenomandibular y las otras porciones del músculo temporal que se pudieran relacionar con las características funcionales del esfenomandibular, identificadas mediante electromiografía. Para obtener estos resultados, se diseccionó el músculo temporal derecho en diez humanos adultos (cinco hombres y cinco mujeres) y se obtuvieron muestras de la porción anterior y posterior del músculo temporal y de su porción esfenomandibular. Estas muestras fueron analizadas mediante RT-qPCR para determinar los porcentajes de expresión de las isoformas MHC-I, MHC- IIa y MHC-IIx. No se identificaron diferencias significativas de los patrones de expresión entre la porción anterior y la porción posterior del músculo temporal, pero sí que se observaron diferencias significativas entre la porción anterior del músculo temporal y su porción esfenomandibular. Concretamente, la porción esfenomandibular presentó un mayor porcentaje de expresión de la isoforma MHC-I (P=0.04) y un menor porcentaje de expresión de la isoforma MHC-IIx (P=0.003). El patrón de expresión que hemos observado en la porción esfenomandibular del músculo temporal refleja una mayor resistencia a la fatiga, una velocidad de contracción más lenta y una menor capacidad de generar fuerza si se compara esta porción con la porción anterior del músclo temporal. Estas características son consistentes con las diferencias funcionales que presentan estas dos porciones, que han sido descritas mediante electromiografía.

Endoscopic transsphenoidal endonasal surgery in pituitary adenomas / Cirugía endoscópica vía endonasal transesfenoidal en adenomas de hipófisis

The pituitary adenomas comprise the largest part of pituitary neoplasms, representing between 9 and 12% of primary brain tumors. Currently, the treatment of election is the surgical, the trans-sphenoidal endonasal path has provided a broader panoramic view, being feasible more delicate and safe procedures. The objective of this study was to describe the management of pituitary adenomas by endoscopic surgery trans-sphenoidal endonasal path. This is a study in a series of cases, with a sample of 17 patients who met the selection criteria and were attended at the José Carrasco Hospital Arteaga, Cuenca - Ecuador, period 2018 - 2019. All patients presented informed consent for the performance of the surgery and the subsequent dissemination of the results. The 53% of the population belonged to the male gender, 47% were patients between 40 and 60 years old, 65% were detected with macroadenomas, and 29% presented complications such as nasal obstruction, sphenoiditis and headache, the residual tumor stage was due 24%.Endoscopic surgery trans-sphenoidal endonasal path is a safe, minimally invasive tool, a surgical alternative with a high rate of tumor excision, better control and fewer complications, which reduces the morbidity of patients.

Los adenomas de hipófisis comprenden la mayor parte de neoplasias hipofisiarias, representando entre el 9 y 12% de los tumores cerebrales primarios. En la actualidad el tratamiento de elección es el quirúrgico, la vía endonasal transesfenoidal ha proporcionado una visión panorámica más amplia, siendo factibles procedimientos más delicados y seguros. El objetivo de este estudio fue describir el abordaje de adenomas de hipófisis mediante cirugía endoscópica vía endonasal transesfenoidal. Diseñamos un estudio de corte longitudinal, con una muestra de 17 pacientes que cumplieron con los criterios de selección y fueron atendidos en el Hospital José Carrasco Arteaga de la ciudad de Cuenca - Ecuador, periodo 2018 - 2019. Todos los pacientes presentaron consentimiento informado para la realización de la cirugía y la posterior difusión de los resultados. El 53% de la población pertenecieron al sexo masculino, 47% fueron pacientes entre 40 y 60 años, al 65% se le detectó macroadenomas, el 29% presentaron complicaciones como obstrucción nasal, esfenoiditis y cefalea, la tasa de tumor residual fue del 24%. La cirugía endoscópica vía endonasal transesfenoidal es una herramienta segura, mínimamente invasiva, una alternativa quirúrgica con una elevada tasa de exéresis tumoral, mejor control y menos complicaciones, que reduce la morbilidad de los pacientes.

Incomplete petrosphenoidal foramen: morphological and morphometric analysis and the proposal of a classification study in Brazilian dry skulls / Foramen petrosfenoidal incompleto: análisis morfológico y morfométrico y propuesta de clasificación: estudio en cráneos secos brasileños

SUMMARY: The complete petrosphenoidal foramen, or canal, is an eventual and atavistic bony formation at the boundary between the posterior and middle cranial fossa, by occurrence of ossification of the superior petrosphenoidal ligament. This ligament ossification, which has important clinical and surgical significance, can be complete or incomplete, in variable degrees, and is associated with the passageway of neurovascular structures, such as the abducens nerve and the inferior petrosal sinus. This study, conducted with 175 dry skulls that belong to the University of São Paulo's collection (USP), São Paulo, Brazil, established criteria for a morphological classification of the incomplete petrosphenoid foramen in nine types. In addition, anatomical parameters were established for the morphometric determination of two diameters: the Oblique Diameter (ObDi) and the Maximum Transverse Diameter (MTD). Thus, of the 175 skulls, 146 (83.42 %) presented some of the incomplete forms of the petrosphenoid foramen, and 43 skulls (29.45 %), due to their conservation characteristics, were habilitated to the morphological study, in the classification and in the morphometry (the types I and II of our classification). The type II (incomplete foramen with bony projections of the petrosal tubercle, of the margin of the dorsum of the hypophyseal fossa or of the posterior clinoid process with a distance between them greater than 1mm) and type V (incomplete foramen with a bony projection only in one of the referential structures - posterior clinoid process) were the most common in this study (50 % of the 86 hemiskulls). Morphometry was attributed only to the types: I selar (incomplete foramen with bony projections from the petrosal tubercle and the margin of the dorsum of the hypophyseal fossa with a distance between them less than or equal to 1mm) and to the type II of this classification. The type I selar (9.3 % of the 43 skulls) resulted in an average of 3.25 mm of MTD and 4.63 mm, on average, of ObDi. The type II (25.58 % of the 43 skulls) showed, on average, 4.93 mm of MTD and 7.01 mm of ObDi.

RESUMEN: El foramen o canal petroesfenoidal completo es una formación ósea eventual y atávica en el límite entre las fosas craneal posterior y media, por osificación del ligamento petroesfenoidal superior. Esta osificación del ligamento, que tiene un importante significado clínico y quirúrgico, puede ser completa o incompleta, en grados variables, y está asociada al paso de estructuras neurovasculares, como el nervio abducente y el seno petroso inferior. Este estudio se realizó en 175 cráneos secos pertenecientes a la colección de la Universidad de São Paulo (USP), São Paulo, Brasil. Se establecieron criterios para una clasificación morfológica del foramen petrosfenoidal incompleto en nueve tipos. Además, se establecieron parámetros anatómicos para la determinación morfométrica de dos diámetros: el Diámetro Oblicuo (ObDi) y el Diámetro Transversal Máximo (MTD). Así, de los 175 cráneos, 146 (83,42 %) presentaron alguna de las formas incompletas del foramen petrosfenoidal, y 43 cráneos (29,45 %), por sus características de conservación, fueron habilitados para el estudio morfológico, en la clasificación y en la morfometría (los tipos I y II de nuestra clasificación). El Tipo II (foramen incompleto con proyecciones óseas del tubérculo petroso, del margen del dorso de la fosa hipofisaria o del proceso clinoides posterior con una distancia entre ellos mayor de 1 mm) y el Tipo V (foramen incompleto con proyección ósea solamente en una de las estructuras referenciales - proceso clinoides posterior) fueron los más comunes en este estudio (50 % de los 86 hemiscráneos). La morfometría se atribuyó únicamente al Tipo I selar (foramen incompleto con proyecciones óseas desde el tubérculo petroso y el margen del dorso de la fosa hipofisaria con una distancia entre ellos menor o igual a 1mm) y al Tipo II de esta clasificación. El Tipo I selar (9,3 % de los 43 cráneos) resultó en un promedio de 3,25 mm de MTD y 4,63 mm, en promedio, de ObDi. El Tipo II (25,58 % de los 43 cráneos) mostró, en promedio, 4,93 mm de MTD y 7,01 mm de ObDi.

Morphometric analyses of the caroticoclinoid and interclinoid foramina: a study in Brazilian dry skulls / Análisis morfométricos del foramen caroticoclinoideo e interclinoideo: un estudio en cráneos secos brasileños

SUMMARY: The caroticoclinoid (CF) and the interclinoid (IF) foramina are variant formations of the middle cranial fossa, which result from idiopathic and possibly atavistic ossifications of the caroticoclinoid and interclinoid ligaments, respectively. Topographically, these foramina are intimately associated, to varying degrees, depending on their conformations, with the neurovascular elements of the paraclinoid region and have important clinical and surgical significance. Thus, this study, conducted from 38 dry skulls belonging to the shared collection of the Federal University of Juiz de Fora, Governador Valadares campus, revealed 11 skulls (28.95 %) with one of the two complete formations - the caroticoclinoid or the interclinoid, and in 6 skulls the caroticoclinoid foramen occurred uni or bilaterally. As a result, 50 % of these skulls presented the CF exclusively on the right (or 62.5 % of the total number of variant foramina), with an average transverse diameter of 4.91 mm and 5.8 mm AP (anteroposterior) diameter and an average area of 22.5 mm2. Concerning the IF, the findings occurred in 5 skulls with variable distributions between the clinoid processes and lateralities. The average length of the bone bridges in the IF was 7.7 mm. In conclusion, detailed anatomical knowledge of the caroticoclinoid and the interclinoid foramina is fundamental to the practice of neurosurgical procedures, since they have intimate relationships at a location of high structural complexity.

RESUMEN: El foramen caroticoclinoideo (FC) y el foramen interclinoideo (IC) son formaciones variables de la fosa craneal media, que resultan de osificaciones idiopáticas y posiblemente atávicas de los ligamentos caroticoclinoideo e interclinoideo, respectivamente. Estos forámenes están íntimamente asociados topográficamente en diversos grados, dependiendo de sus conformaciones, con los elementos neurovasculares de la región paraclinoidea y tienen importancia clínica y quirúrgica. Así, este estudio, realizado a partir de 38 cráneos secos pertenecientes a la colección compartida de la Universidad Federal de Juiz de Fora, campus Governador Valadares, reveló 11 cráneos (28,95 %) con una de las dos formaciones completas: el FC o el IC, y en 6 cráneos el FC se presentó uni o bilateralmente. Como resultado, el 50 % de estos cráneos presentaba el FC exclusivamente a la derecha (o el 62,5 % del total de forámenes variantes), con un diámetro transversal medio de 4,91 mm y un diámetro anteroposterior medio de 5,8 mm y un área promedio de 22,5 mm2. En cuanto a la FI, los hallazgos se presentaban en 5 cráneos con distribuciones variables entre los procesos clinoides y lateralidades. La longitud media de los puentes óseos en el FI fue de 7,7 mm. En conclusión, el conocimiento anatómico detallado de los forámenes caroticoclinoideo e interclinoideo resulta fundamental para la práctica de procedimientos neuroquirúrgicos, ya que presentan relaciones íntimas en un lugar de alta complejidad estructural.

Anatomical variations and morphometric study of pterion in a Thai population associated with clinical implications / Variaciones anatómicas y estudio morfométrico del pterion en una población tailandesa asociada con implicaciones clínicas

SUMMARY: The objective of this study was to consider the type of variation and to estimate the landmarks for localizing the pterion. One hundred twenty Thai dry skulls were selected randomly from the Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University. The distances of the parameters were measured via Vernier caliper. The sphenoparietal type is the most dominant in the Thai population with 88.75 %. In the male, the distance of the midglabella to the pterion was 9.94?0.64 mm The distance of the frontozygomatic suture to the pterion was 35.41?4.38 mm The distance of the zygomatic arch to the pterion was 39.39?4.69 mm and the distance of the mastoid process tip to the pterion was 86.88?4.44 mm In the female, the distance of the midglabella to the pterion was 9.27?0.63 mm The distance of the frontozygomatic suture to the pterion was 33.08?4.12 mm The distance of the zygomatic arch to the pterion was 33.08?4.12 mm and the distance of the mastoid process tip to the pterion was 83.62?5.16 mm. The pterion approach is the most popular method for neurosurgical procedures, and it provides anatomical variations in the pattern. The sphenoparietal type of pterion is the most common form and the stellate type of pterion is the least common form in Thai skulls. Sex influences the location of the pterion. These findings will be of importance to predict the pterion type in Thai skull and estimate the localization of pterion by using a bony landmark. Knowledge of the precise location of the pterion is an important landmark in the neurosurgical approach.

RESUMEN: El objetivo de este estudio fue considerar el tipo de variación del pterion y estimar los puntos de referencia para localizarlo. Se seleccionaron al azar 120 cráneos secos de individuos tailandeses del Centro de Investigación de Osteología Forense de la Facultad de Medicina de la Universidad de Chiang Mai. Las distancias de los parámetros se midieron mediante un caliper Vernier. El tipo esfenoparietal es el más dominante en la población tailandesa con 88,75 %. En el hombre, la distancia de la glabella al pterion fue de 9,94 ? 0,64 mm. La distancia de la sutura frontocigomática fue de 35,41 ? 4,38 mm La distancia del arco cigomático fue de 39,39 ? 4,69 mm y la distancia del ápice del proceso mastoideo al pterion fue de 86,88 ? 4,44 mm. En la mujer, la distancia de la glabella al pterion fue de 9,27 ? 0,63 mm. La distancia de la sutura frontocigomática al pterion fue de 33,08 ? 4,12 mm. La distancia del arco cigomático al pterion fue de 33,08 ? 4,12 mm y la distancia del ápice proceso mastoideo al pterion fue de 83,62 ? 5,16 mm. El abordaje del pterion es el método más utilizado para procedimientos neuroquirúrgicos y proporciona variaciones anatómicas en el patrón. El tipo esfenoparietal del pterion es la forma más común y el tipo estrellado del pterion es la forma menos común en los cráneos tailandeses. El sexo influye en la ubicación del pterion. Estos hallazgos serán importantes para predecir el tipo de pterion del cráneo en tailandeses y a la vez estimar su localización mediante el uso de un punto de referencia óseo. El conocimiento de la ubicación precisa del pterion es un hito impor- tante en el abordaje neuroquirúrgico.

The pterygospinous foramen (Civinini) and the pterygoalar (crotaphitico-buccinatorius): laboratory findings / El foramen pterigoespinoso (Civinini) y el pterigoalar (crotafítico-buccinatorius): hallazgos de laboratorio

SUMMARY: The Pterygospinous foramen and pterygoalar foramen (crotaphitico-buccinatorius) are variant and atavic formations of the skull base and arise respectively from complete or incomplete idiopathic ossifications of the pterygospinous and pterygoalar ligaments. By proximity with areas of relevance for diagnosis and surgery, such as access pathways to the parapharyngeal and retropharyngeal spaces, it is necessary to be aware of these conditions due to the difficulties generated in surgical maneuvers and the promotion of compressive syndromes of mandibular nerve branches. This study was conducted on 45 samples of dry skulls and disarticulated sphenoid bones belonging to the collection of the Federal University of Juiz de Fora, Governador Valadares campus, Minas Gerais, Brazil. Our results indicated a total incidence of complete and incomplete pterygospinous and pterygoalar foramen (crotaphitico- buccinatorius) in 15, 5 % (7 skulls), with a higher incidence for the incomplete form of pterygospinous foramen (Civinini foramen) in 4 skulls (8.8 %), with 3 presenting unilaterally and 3 presenting bilaterally. The pterygoalar foramen (crotaphitico-buccinatorius or Hyrtl) was noted bilaterally in 1 of the skulls (2.2 %). The pterygospinous foramen and pterygoalar foramen are important findings, sometimes incidental, of an area of great anatomical expressiveness and pathological occurrences, besides the indispensable and unclear studies of phylogenetic order.

RESUMEN: El foramen pterigoespinoso y el foramen pterigoalar (crotafítico-buccinatorius) son formaciones variantes y atávicas de la base del cráneo y surgen respectivamente de osificaciones idiopáticas completas o incompletas, de los ligamentos pterigoespinoso y pterigoalar. Debido a la proximidad con áreas de relevancia para el diagnóstico y la cirugía, como las vías de acceso a los espacios parafaríngeo y retrofaríngeo, es necesario conocer estas condiciones por las dificultades que se generan en las maniobras quirúrgicas. Este estudio se realizó en 45 muestras de cráneos secos y huesos esfenoides desarticulados pertenecientes a la colección de la Universidad Federal de Juiz de Fora, campus Governador Valadares, Minas Gerais, Brasil. Nuestros resultados indicaron una incidencia total de foramen pterigoespinoso y pterigoalar completo e incompleto (crotafítico-buccinatorius) en el 15,5 % (7 cráneos), con una mayor incidencia de la forma incompleta de foramen pterigoespinoso (agujero de Civinini) en 4 cráneos (8,8 %), con 3 de presentación unilateral y 3 de presentación bilateral. El foramen pterigoalar (crotaphitico-buccinatorius o Hyrtl) se observó bilateralmente en 1 de los cráneos (2,2 %). El foramen pterigoespinoso y pterigoalar son hallazgos importantes, a veces incidentales, de un área de gran expresividad anatómica y ocurrencias patológicas, además de los estudios indispensables y poco claros de orden filogenético.

Radioanatomic study on the role of Hadad-Bassagasteguy flap in skull base reconstruction in endoscopic endonasal approach / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the value of Hadad-Bassagasteguy flap (HBF) in endoscopic endonasal approaches (EEA) skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults. The following data in terms of anterior skull base defect and reconstruction, sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area, clivus area defect and reconstruction, and HBF were collected and assessed. Methods: CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF, anterior skull base defect and reconstruction, middle skull base defect and reconstruction, and defect and reconstruction of clivus area. SPSS 26.0 software was used to analyze the data. Results: The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained. The width of the leading edge of HBF [(37.49±2.86) mm] was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery [(30.87±8.61) mm], and the width of the trailing edge of HBF [(42.61±3.95) mm] was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction [(26.79±2.79) mm]. The total length of HBF including the pedicle [(79.68±4.96) mm] was 6 mm more than the length of the anterior skull base reconstruction [(54.06±8.67) mm], and the length of HBF without pedicle [(46.27±3.14)] mm was 6 mm more than the length of anterior skull base defect [(30.87±8.61) mm]. The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut [(30.87±8.61) mm]. The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal, and the sella reconstruction [(64.44±10.25) mm], also was 6 mm more than the length of the planum sphenoidal reconstruction [(73.61±8.28) mm]. The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal, and the sella defect [(27.88±3.74) mm], also was 6 mm more than the length of the planum sphenoidal defect [(15.50±3.38) mm]. The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum [(21.68±2.30) mm]. The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length [(67.09±5.44) mm], while the length of HBF without pedicles was also 6 mm more than the clivus defect length [(37.19±3.80) mm]. Conclusions: In this study, the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus. Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction, which provides important guidance for flap harvest.

Morphology of the pterion in Serbian population / Morfología del pterion en población serbia

The pterion is a topographic point on the lateral aspect of the skull where frontal, sphenoid, parietal and temporal bones form the H or K shaped suture. This is an important surgical point for the lesions in anterior and middle cranial fossa. This study was performed on 50 dry skulls from Serbian adult individuals from Department of Anatomy, Faculty of Medicine in Novi Sad. The type of the pterion on both sides of each skull was determined and they are calcified in four types (sphenoparietal, frontotemporal, stellate and epipteric). The distance between the center of the pterion and defined anthropological landmarks were measured using the ImageJ software. Sphenoparietal type is predominant with 86 % in right side and 88 % in left side. In male skulls, the distance from the right pterion to the frontozygomatic suture is 39.89±3.85 mm and 39.67±4.61 mm from the left pterion to the frontozygomatic suture. In female skulls the distance is 37.38±6.38 mm on the right and 35.94±6.46 mm on the left. The shape and the localization of the pterion are important because it is an anatomical landmark and should be used in neurosurgery, traumatology and ophthalmology.

El pterion es un punto topográfico en la cara lateral del cráneo donde los huesos frontales, esfenoides, parietales y temporales forman la sutura en forma de H o K. Este es un punto quirúrgico importante para las lesiones en la fosa craneal anterior y media. Este estudio se realizó en 50 cráneos secos de adultos serbios del Departamento de Anatomía de la Facultad de Medicina de Novi Sad. Se determinó el tipo de pterión en ambos lados de cada cráneo y se calcifican en cuatro tipos (esfenoparietal, frontotemporal, estrellado y epipterico). La distancia entre el centro del pterion y los puntos de referencia antropológicos definidos se midió utilizando el software ImageJ. El tipo esfenoparietal es predominante con 86 % en el lado derecho y 88 % en el lado izquierdo. En los cráneos masculinos, la distancia desde el pterion derecho hasta la sutura frontocigomática es 39,89 ± 3,85 mm y 39,67 ± 4,61 mm desde el pterion izquierdo hasta la sutura frontocigomática. En los cráneos femeninos, la distancia es 37,38 ± 6,38 mm a la derecha y 35,94 ± 6,46 mm a la izquierda. La forma y la localización del pterion son importantes debido a que es un indicador anatómico y debe usarse en neurocirugía, traumatología y oftalmología.

Cirugía neurológica en meningioma del tercio medio del ala del esfenoides. Presentación de un caso / Neurological surgery in meningioma of the middle third of the wing of the sphenoid. Presentation of a case

RESUMEN Se presentó un caso de una paciente de 70 años de edad, con antecedentes patológicos personales de hipertensión arterial controlada, además de un síndrome demencial instaurado hace 5 años aproximadamente. Con un diagnóstico presuntivo de una demencia tipo Alzheimer y sin estudios desde el punto de vista imagenológico. Se le realizaron diversos estudios que arrojaron una lesión extraaxial interpretada como un meningioma del tercio medio del ala del esfenoides. Se le aplicó una resección tumoral de la totalidad de la lesión, su evolución postquirúrgica fue satisfactoria.

ABSTRACT The case presented is the one of a female patient aged 70 years, with personal pathological antecedents of controlled arterial hypertension besides dementia syndrome for around five years, presumptively diagnosed as Alzheimer-kind dementia without imaging studies. She underwent several studies showing an extra axial lesion that was interpreted as meningioma of the medial third of the sphenoid wing. The tumor resection of the entire lesion was carried out; the post-surgery evaluation was satisfactory.

Anatomical and clinical significance of pterygospinous and pterygoalar ligaments and bony bars in dentistry / Significado anatómico y clínico de los ligamentos pterigoespinoso y pterigoalar y los puentes óseos en odontología

The Pterygospinous Ligament (PSL) extends from the Pterygospinous process of the lateral Pterygoid plate to the spine of the sphenoid bone. Sometimes, it may be ossified forming a bar of bone bounding the pterygospinous foramen to which mandibular nerve and its branches are variably related. Mandibular and chorda tympani nerves may get compressed depicting various clinical symptoms, which in turn depend upon dimensions of the foramen and grades of compression. Therefore, knowledge of the position and extent of ossification of PSL and its relation to the important structures in the deep infratemporal fossa is important for radiologists, neurologists, maxillofacial surgeons, dental surgeons and anesthesiologists during various anesthetic and surgical procedures.

El ligamento Pterigoespinoso (LP) se extiende desde el proceso Pterigoespinoso de la placa Pterigoideo lateral a la espina etmoidal del hueso esfenoides. A veces, se puede osificar formando un puente de hueso que une el foramen espinoso con el cual el nervio mandibular y sus ramas están relacionados de manera variable. Los nervios mandibulares y el cordón timpánico se pueden comprimir resultando en diversos síntomas clínicos, que a su vez dependen de las dimensiones del foramen y los grados de compresión. Por lo tanto, el conocimiento de la posición y el grado de osificación del ligamento pterigoespinoso y su relación con las estructuras importantes en la fosa infratemporal profunda es importante para radiólogos, neurólogos, cirujanos maxilofaciales, cirujanos dentales y anestesistas durante diversos procedimientos anestésicos y quirúrgicos.

Combined extracranial and intracranial approach for resection of dermoid cyst of the sphenoid bone with a cutaneous sinus tract across the frontal branch of the facial nerve

Frontotemporal dermoid cysts with a cutaneous sinus tract in the sphenoid bone are rarely found, and furthermore, the spreading of these cysts across the frontal branch of the facial nerve has not been reported. Herein, we present a 5-year-old case of a dermoid cyst successfully resected with preservation of this nerve using a combined extracranial and intracranial approach. This approach is recommended for a safe and radical resection of the lesion and for securing an aesthetic outcome.

Infratemporal fossa approach: the modified zygomatico-transmandibular approach / 대한악안면성형재건외과학회지

BACKGROUND: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. METHODS: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors’ diverse clinical experiences. RESULTS: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. CONCLUSIONS: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.

Morphological and morphometric characterization of the "sphenoidal tubercle" / Caracterización morfológica y morfométrica del tubérculo esfenoidal

The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.

El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.

Classification and incidence of pterion patterns of Thai skulls / Clasificación e incidencia de los patrones de pterion en cráneos de Tailandia

SUMMARY: The pterion, a landmark for neurosurgery, is the weakest part of the skull owing to relatively thin bone. Variant patterns of pterion can confuse the clinicians during diagnosis of the lateral skull fractures in emergency situations. Thedifferent pterion types of many races have been reported but not of Thais. In this study; therefore, we investigated the incidence of sutural pterion patterns on of Thai skulls. The infratemporal fossa of 110 sides from 55 dried skulls identified as Thais were observed and classified for individual pterion types. The results showed that the pterion patterns can be classified into 4 types; spheno-parietal (87.27 %), fronto-temporal (4.55 %), uni-epipteric (6.36 %), and multi-epipteric (1.82 %) types. It was found that the spheno-parietal type was dominant in males (61.81 %) than in females (25.45 %). The majority of the skulls showed bilateral symmetry (85.45 %) in all types and the unilateral ones were far less (14.55 %). In bilateral pterion incidence, the spheno-parietal type was approximately 93.61 % while the uni-epipteric type was not found. Moreover, the bilateral multi-epipteric type was found only in one female skull (2.13 %). These findings will be useful for the radiologists and the neurosurgeons concerning lateral skull fractures in emergency diagnosis.

RESUMEN: El pterion es un punto de referencia para la neurocirugía, y es la parte más débil del cráneo debido a estar conformado por hueso relativamente delgado. Los diversos patrones de pterion pueden confundir a los clínicos durante el diagnóstico de fracturas laterales de cráneo en situaciones de emergencia. Con excepción de los tailandeses, diferentes tipos de pterion se han reportado en muchas razas. hemos investigado la incidencia de diversos patrones de pterion en cráneos de Tailandia. Analizamos 110 fosas infratemporales, correspondientes a 55 cráneos secos del Noreste de Tailandia y se clasificaron de acuerdo al tipo de pterion. Los resultados mostraron que el pterion puede clasificarse en 4 tipos: esfeno-parietal (87,27 %), fronto-temporal (4,55 %), epiptérico (3,63 %) y multi-epiptérico (1,81 %). Se encontró que el tipo esfeno-parietal tuvo mayor incidencia en hombres (61,81 %) que en mujeres (25,45 %). Además, la incidencia de simetría bilateral (85,45 %) fue mayor que la unilateral (14,55 %). A nivel bilateral, el tipo esfeno-parietal fue de 93,61 %, mientras que el tipo epiptérico no se observó. Por otra parte, el tipo multiepiptérico fue encontrado bilateralmente en un solo cráneo femenino (2,13 %). Esta incidencia puede ser utilizada como un conocimiento básico para los radiólogos tailandeses sobre las fracturas laterales del cráneo en un diagnóstico de emergencia.

The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships / Seio esfenoidal, forame redondo e canal pterigoideo: estudo radiológico das relações anatômicas

Abstract Introduction: The sphenoid sinus is an important structure in ventral skull base surgeries that is surrounded by several vital anatomical structures including the internal carotid arteries, optic nerve and cranial nerves inside the cavernous sinus. In addition, the foramen rotundum is a small canal deeply situated in the base of the skull, which represents the way for exit of the maxillary nerve. Understanding of the sphenoid bone anatomical relationships is central to the expanded endonasal approaches to the skull base. Objective: To record and analyze the measurement indexes of the sphenoid sinus and foramen rotundum in the coronal plane of normal computer tomography scans. Methods: Patients underwent paranasal sinuses computer tomography scan from June 2014 to November 2015 were retrospectively entered this cross-sectional study. We obtained several morphometric measurements from both the right and left sides using computer software. We also classified foramen rotundum and vidian canal types and determined position of the foramen rotundum regarding to base of lateral pterygoid plate. Results: One-hundred patients with the mean age of 38.56 ± 18.51 years entered this study. Mean bilateral FR distances were 38.48 ± 3.87 mm. Average right and left FRs distances to midline were 19.00 ± 2.07 and 19.34 ± 2.17 mm, respectively (p = 0.03). Twenty-eight cases (28%) had type I vidian canal, 48% and 24% had type II and III vidian canals, respectively. Four patients (4%) had type I rotundum foramen, 28% and 44% had type IIa and IIb, respectively and 24% had type III rotundum foramen. The position of foramen rotundums regarding to the base of lateral pterygoid plate was online in 50% of cases, medially placed in 47% and laterally placed in 3% of cases. Conclusion: The results of this study can be used to provide a better anatomical understanding of the area, which is necessary for endoscopic skull base surgeons.

Resumo Introdução: O seio esfenoidal (SE) é uma estrutura importante em cirurgias da base do crânio, que está cercada por várias estruturas anatômicas vitais, como as artérias carótidas internas, o nervo óptico e os nervos cranianos no interior do seio cavernoso. Além disso, o forame redondo (FR) é um pequeno canal profundamente situado na base do crânio, que representa a forma de saída do nervo maxilar. Compreender as relações anatômicas do osso esfenoidal é fundamental para as abordagens endonasais expandidas da base do crânio. Objetivo: Registrar e analisar os índices de medição do SE e FR no plano coronal de exames normais de tomografia computadorizada (TC). Método: Os pacientes que foram submetidos a TC dos seios paranasais (SPN) de junho de 2014 a novembro 2015 foram retrospectivamente incluídos neste estudo transversal. Obtivemos várias medidas morfométricas de ambos os lados, direito e esquerdo, com o uso do software de computador. Também classificamos os tipos de FR e canal pterigoideo (CP) e determinamos a posição do FR em relação à base da placa pterigoide lateral. Resultados: Cem pacientes com a média de 38,56 ± 18,51 anos foram incluídos neste estudo. As distâncias médias bilaterais de FR foram de 38,48 ± 3,87 mm. As distâncias médias direita e esquerda dos FR até a linha média foram de 19,00 ± 2,07 e 19,34 ± 2,17 mm, respectivamente (p = 0,03). Vinte e oito casos (28%) tinham canal pterigoideo do tipo I, 48% e 24% canais pterigoideos de tipo II e III, respectivamente. Quatro pacientes (4%) tinham forame redondo do tipo I, 28% e 44% do tipo II-a e II-b, respectivamente, e 24% forame redondo do tipo III. A posição dos FR em relação à base da placa pterigoide lateral era em linha em 50% dos casos, medialmente posicionados em 47% e lateralmente posicionados em 3% dos casos. Conclusão: Os resultados deste estudo podem ser usados para promover uma melhor compreensão anatômica da área, necessária para cirurgias endoscópicas da base do crânio.

Comparison of bone scintigraphy with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) in the detection of sphenoid bone extension from nasopharyngeal carcinoma (NPCA): A retrospective study

BACKGROUND/OBJECTIVE: Skeletal metastasis is one of the major clinical problems in managing cases of NPCA. Beginning osseous metastasis in the form of sphenoid bone extension is commonly seen in NPCA.Imaging modalities mainly used in detecting sphenoid bone extension are bone scintigraphy with SPECT and MRI. In this paper, the ability of bone scintigraphy with SPECT and MRI in detecting sphenoid bone extension was compared.MATERIALS AND METHODS: Twelve patients with nasopharyngeal carcinoma were studied by bone scintigraphy with SPECT and MRI. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each modality against the gold standard, which is sphenoid bone biopsy, were computed. Statistical analysis was done using the McNemar's Test.RESULTS: The overall performances of bone scintigraphy with SPECT versus MRI were the following: sensitivity 89% vs 78%, specificity 33% vs 67%, positive predictive value 80% vs 88% and negative predictive value 50% vs 50%. There was no significant difference between the two modalities using McNemar's test (p>0.05).CONCLUSION: Bone scintigraphy with SPECT and MRI were both equally effective and were complementary with each other in detecting sphenoid bone extension in patients with NPCA.

Comparison of bone scintigraphy with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) in the detection of sphenoid bone extension from nasopharyngeal carcinoma (NPCA): A retrospective study

BACKGROUND/OBJECTIVE: Skeletal metastasis is one of the major clinical problems in managing cases of NPCA. Beginning osseous metastasis in the form of sphenoid bone extension is commonly seen in NPCA.Imaging modalities mainly used in detecting sphenoid bone extension are bone scintigraphy with SPECT and MRI. In this paper, the ability of bone scintigraphy with SPECT and MRI in detecting sphenoid bone extension was compared.MATERIALS AND METHODS: Twelve patients with nasopharyngeal carcinoma were studied by bone scintigraphy with SPECT and MRI. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each modality against the gold standard, which is sphenoid bone biopsy, were computed. Statistical analysis was done using the McNemar's Test.RESULTS: The overall performances of bone scintigraphy with SPECT versus MRI were the following: sensitivity 89% vs 78%, specificity 33% vs 67%, positive predictive value 80% vs 88% and negative predictive value 50% vs 50%. There was no significant difference between the two modalities using McNemar's test (p>0.05).CONCLUSION: Bone scintigraphy with SPECT and MRI were both equally effective and were complementary with each other in detecting sphenoid bone extension in patients with NPCA.