Osteological Study of the Parietal Foramen in the Adult Human Skull Bones and its Clinical and Surgical Correlations / Estudio Osteológico del Foramen Parietal en los Huesos del Cráneo Humano Adulto y sus Correlaciones Clínicas y Quirúrgicas

SUMMARY: Parietal emissary foramina (PEF) are small holes, which are localized between the middle and posterior thirds of the parietal bone posterior surface close to the sagittal suture. PEF are important structures that protect the parietal emissary vein, which passes through it. During neurosurgery procedures, parietal foramina (PF) knowledge is crucial. This work aimed to evaluate presence and location of the PF in the skull of an adult human. Moreover, measure the distance amidst PF and the sagittal suture's midline to ascertain its clinical repercussions. 74 adult human skulls, without gross pathology, were observed for the PF's existence. The PF's and sagittal suture's midline distance were measured. According to the PF patterns of presence, five groups were distributed. Finally, specimens were photographed and subjected to statistical analysis. The PF was absent in 7 skulls (9.5 %). There were 9 skulls (12.2 %) exhibited central parietal foramen where the parietal foramen lies on the sagittal suture. 17 skulls (23 %) showed right unilateral parietal foramen, whereas 15 skulls (20.3 %) demonstrated left unilateral parietal foramen. The final 26 skulls (35.1 %) exhibited bilateral parietal foramen. This descriptive study supplies valuable information of PF variations, which is crucial for neurosurgeons in modifying surgical techniques and procedures to alleviate injury to PF-emerging structures such as emissary veins.

Los forámenes emisarios parietales (FEP) son pequeños orificios que se localizan entre los tercios medio y posterior de la superficie posterior del hueso parietal, cerca de la sutura sagital. Los FEP son estructuras importantes que protegen la vena emisaria parietal, que lo atraviesa. Durante los procedimientos de neurocirugía, el conocimiento de los forámenes parietales (FP) es crucial. Este trabajo tuvo como objetivo evaluar la presencia y ubicación del FP en el cráneo de hombres adultos, además, medir la distancia entre el FP y la línea mediana de la sutura sagital para conocer su repercusión clínica. Se examinaron 74 cráneos humanos adultos, sin patología grave, para determinar la existencia del FP. Se midió la distancia de la línea mediana de la sutura sagital y del FP. De acuerdo con los patrones de presencia del FP, se distribuyeron en cinco grupos. Finalmente, los especímenes fueron fotografiados y sometidos a análisis estadístico. El PF estaba ausente en 7 cráneos (9,5 %). Hubo 9 cráneos (12,2 %) que presentaban un PF central localizándose en la sutura sagital. 17 cráneos (23 %) presentaban un FP unilateral derecho, mientras que 15 cráneos (20,3 %) se observó un FP unilateral izquierdo. Los 26 cráneos restantes (35,1 %) exhibieron FP bilaterales. Este estudio descriptivo proporciona información valiosa sobre las variaciones del FP, que es fundamental para los neurocirujanos en el momento de modificar las técnicas y los procedimientos quirúrgicos para aliviar las lesiones de las estructuras emergentes del FP, como las venas emisarias.

Multiple osteotomies with combined distraction osteogenesis for non-syndromic scaphocephaly / 中华整形外科杂志

Objective@#To evaluate the clinical effect of multiple osteotomies combined with distraction osteogenesis in the treatment of non-syndromic scaphocephaly infants and young children.@*Methods@#Clinical records of 8 non-syndromic scaphocephaly patients, during January 2017 to October 2018, from the Department of Burn and Plastic Surgery, Children′s Hospital of Nanjing Medical University, were retrospectively analyzed. There were 3 males and 5 females, aged from 3 to 28 months, with an average of 13 months. Among them, 4 cases were typical scaphocephaly, 2 cases were anterior scaphocephaly and 2 cases were posterior scaphocephaly. According to the subtypes of scaphocephaly, different osteotomy methods and distraction directions were designed. The cranial vault was osteotomized by piezosurgery osteotomy in a multiple way. The dura did not separate from cranial flap. The internal distractors were installed subsequently. After a mean latency period of 5 days, the devices were activated at a rate of 0.4-0.6 mm/d. Distractor was extended twice a day. After 10-15 days activation period and 6 months consolidation, all the distractors were removed. Three-dimensional CT scans were performed before and after operation to measure the anteroposterior and bitemporal diameters, so as to calculate the cranial index.@*Results@#Follow-up ranged from 6 to 14 months (average, 10 months). The average anteroposterior length of 8 children was(158.2±12.9) mm before operation, and (145.5±14.2) mm after operation, which was shortened(12.6±3.4) mm. Bitemporal diameters was(99.6±8.6) mm preoperatively and(113.9±7.5) mm postoperatively, which was widened (14.2±2.8) mm. Preoperative and postoperative cranial index was 63.2 and 78.3, respectively. The scaphocephalic head shape was significantly improved in all patients. There was no serious complications such as skull necrosis or intracranial infection.@*Conclusions@#Different types of multiple osteotomy combined with distraction osteogenesis are useful to correct various scaphocephaly of infants and children, by improving skull shape and cranial index.

Relationship of the parietal foramen and complexity of the human sagittal suture / Relación del foramen parietal y la complejidad de la sutura sagital humana

The purpose of this paper is to report on the relationship between the parietal foramen and complexity of the human sagittal suture. Examination of 110 Japanese human skulls (males=67, females=43) with at least one parietal foramen revealed that the sagittal suture in the area of the Obelion was the simplest portion (i.e., fewest interdigitations and shortest length) of the suture (paired t-test, P<0.0005), when compared to the outstretched suture length of three established sections: 1. Parietal foramen section (P); 2. Anterior to section P (B); and 3. Posterior to section P (L). Sutural complexity was also compared between individuals with unilateral foramen (n=48) and bilateral foramina (n=62) to see if there was a statistically significant difference. The results revealed a slight difference in section P (ANOVA Bonferroni, P<0.05), denoting that the sagittal suture at the Obelion in individuals with unilateral parietal foramen is more complex than in individuals with bilateral foramina. While no difference in sex was noted, this simplicity in part likely reflects redirected bone stresses around a circular opening resulting in reduced tensile stresses and increased compressive stresses adjacent to the parietal foramen. This phenomenon warrants additional research and has implications for bone biomechanics and development of the cranial sutures.

El propósito de este trabajo es informar sobre la relación entre el foramen parietal y la complejidad de la sutura sagital en humanos. Se examinaron 110 cráneos humanos de individuos japoneses (hombres = 67, mujeres = 43) con al menos un foramen parietal, revelando que la sutura sagital en el área del obelion fue la parte más simple (es decir, menos interdigitaciones y menor longitud) de la sutura (vinculado la prueba t, p <0,0005). Cuando se comparó la extensión de la longitud de la sutura se establecieron tres secciones: 1. Sección foramen parietal (P); 2. Anterior a la sección P (B), y 3. Posterior a la sección P (L). La complejidad de la sutura también fue comparada entre los individuos con foramen unilateral (n = 48) y forámenes bilaterales (n = 62) para ver si había una diferencia estadísticamente significativa. Los resultados revelaron una ligera diferencia en la sección P (ANOVA Bonferroni, P <0,05), que indica que la sutura sagital a nivel del obelion en los individuos con foramen parietal unilateral es más compleja que en los individuos con forámenes bilaterales. Si bien no hubo diferencia según sexo, esta simplicidad en parte, probablemente refleja la redirección de las fuerzas del hueso alrededor de una abertura circular, lo que reduce la resistencia a la tracción y aumenta la fuerza de compresión adyacente al foramen parietal. Este fenómeno justifica la investigación adicional y tiene implicaciones para el desarrollo óseo y biomecánica de las suturas craneales.

Distraction Osteogenesis for Early Correction of Sagittal Craniosynostosis

Sagittal synostosis with related functional aspects of elevated ICP, hydrocephalus, mental retardation and visual abnormalities, or with multiple suture synostosis, surgical correction is imperative. But, craniofacial surgery may impose a threat to an infant or small child. The blood volume in these patients is small and a minor hemorrhage may induce proportionately greater blood loss, resulting in a greater stress to the patient's system. Mortality resulting from craniofacial surgery is uncommon, mostly from operative hemorrhage and infections. Releasing the stenosis and reshaping the cranial vault is the primary operative goal. Authors sought to minimize surgical stress on the child and attain control of cranial vault reshaping by gradual distraction osteogenesis in treating children with sagittal suture synostosis. Three sagittal synostosis patients, aged from 11 months to 3 years old were treated. One of the patients had multiple suture synostosis. Patient follow-up ranged from 3 months to 3 years. Biparietal bone flap was elevated and external distraction devices were inserted. Distraction rate varied from 0.5 to 1mm/day, without a latency period. After a consolidation period of 2-3weeks, the devices were removed. Functional aspects of ICP and mental retardation subsided post surgery. Radiological follow-up showed cessation of enhancement of bone deposition at the frontal and occipital sutures. Excellent aesthetic results were accounted for in all three of the patients. Application of distraction osteogenesis in correcting sagittal craniosynostosis is very effective; surgical stress on the patients is minimal and controlled cranial vault reshaping is possible.