Morphometric Analysis of Stylomastoid Foramen and its Clinical Significance / Análisis Morfométrico del Foramen Estilomastoideo y su Importancia Clínica

SUMMARY: The stylomastoid foramen is located on the inferior surface of the petrous part of the temporal bone between the base of the styloid process and mastoid processes. Through the stylomastoid foramen the facial nerve completes its intracranial part. The aim of this study was to analyze the morphometric parameters, shape and position of the stylomastoid foramen on the skulls in Serbian population, and to correlate it with gender and body side. The study included 44 dry adult skulls (88 stylomastoid foramen). After we determined the gender, the skulls were photographed, and then distances of the stylomastoid foramen from various important landmarks of the skull base were measured in programme ImageJ. The shape and position of the stylomastoid foramen were also noted. The statistical significance was found in male skulls between right and left side in relation to parameter (P2) the shortest distance from the upper end of the anterior margin of the mastoid process (MP) to the center of stylomastoid foramen (CSMF), and on the left side for parameter (P6) the shortest distance between CSMF and the line passing through the tip of the MP in relation to gender. The most common shape of the stylomastoid foramen was round in 46 (52.27 %) cases, and most common position was on the line passing through the upper end of the anterior margin of both MP in 36 (40.91 %) and medially to the line connecting the tips of the MP and styloid process in 88 (100 %) cases. The results of this study will be useful for neurosurgeons during surgeries on the facial nerve trunk or anesthetics to give facial nerve block near the foramen and prevent its complications.

El foramen estilomastoideo se encuentra en la superficie inferior de la parte petrosa del hueso temporal entre la base del proceso estiloides y el proceso mastoides. A través del foramen estilomastoideo el nervio facial completa su parte intracraneal. El objetivo de este estudio fue analizar los parámetros morfométricos, la forma y la posición del foramen estilomastoideo en cráneos de población serbia y correlacionarlos con el sexo y el lado del cuerpo. El estudio incluyó 44 cráneos adultos secos (88 forámenes estilomastoideos). Después de determinar el sexo, se fotografiaron los cráneos y luego se midieron en el programa ImageJ las distancias del foramen estilomastoideo desde varios puntos importantes de la base del cráneo. También se observó la forma y posición del foramen estilomastoideo. La significación estadística se encontró en cráneos de hombres entre el lado derecho e izquierdo en relación al parámetro (P2) la distancia más corta desde el extremo superior del margen anterior del proceso mastoides (PM) hasta el centro del foramen estilomastoideo (CFM), y en el lado izquierdo para el parámetro (P6) la distancia más corta entre CFM y la línea que pasa por la punta del PM en relación al sexo. La forma más común del foramen estilomastoideo era redonda en 46 (52,27 %) casos, y la posición más común estaba en la línea que pasa por el extremo superior del margen anterior de ambos PM en 36 (40,91 %) y medialmente a la línea que conecta las puntas del PM y el proceso estiloides en 88 (100 %) casos. Los resultados de este estudio serán útiles para los neurocirujanos durante las cirugías en el tronco del nervio facial o los anestésicos para bloquear el nervio facial cerca del foramen y prevenir sus complicaciones.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Analysis and 3D Imaging of Morphometric - Mineral Structure Changes in Skulls of Male and Female Guinea Pigs During and After Developmental Period

SUMMARY: Even though morphometric and mineral studies related to the guinea pig (Cavia porcellus) skull have been carried out, this study is the first attempt to evaluate all developmental stages of male and female guinea pigs. This study aims to this study is to create 3D modeling of CT images obtained from the skulls of male and female guinea pigs during the developmental period (prepuberty and the period between puberty and adulthood) and following periods (young adulthood and old adulthood), to analyze some biometric bone data such as volume, surface area and length, and to assess the developmental analysis of the mineral matter change in their skulls. The CT-scanned skulls were transferred to 3D Slicer (5.0.2), which is used for 3D modeling. The surface area and volume were calculated by measuring the measurement points on the models. In addition, the XRF device was used to show elemental ratio changes during different developmental stages. According to metric measurements, a gradual increase was observed during the life period. The metric measurements of the skull bone had a higher measurement value in male guinea pigs than in their female counterparts. While Ca/P ratio increased up to the third group and partially decreased in the fourth group in males, it gradually increased from the first group to the fourth group in females. This study revealed that puberty, adulthood and sex were effective in the physical and chemical characterization of skull bone structure in guinea pigs.

Aunque se han realizado estudios morfométricos y de minerales relacionados con el cráneo del cobayo (Cavia porcellus), esta investigación es el primer intento de evaluar las etapas de desarrollo de cobayos machos y hembras. El objetivo de este estudio fue crear un modelado 3D de imágenes de tomografía computarizada obtenidas de los cráneos de cobayos machos y hembras durante el período de desarrollo (prepubertad y el período entre la pubertad y la edad adulta) y los períodos siguientes (edad adulta joven y edad adulta mayor), para analizar algunos datos biométricos de los huesos, como el volumen, la superficie y la longitud, y además, analizar el cambio de materia mineral en sus cráneos durante el desarrollo. Los cráneos escaneados se transfirieron a 3D Slicer (5.0.2), que se utiliza para el modelado 3D. El área de superficie y el volumen se calcularon midiendo los puntos de medición en los modelos. Además, se utilizó el dispositivo XRF para mostrar los cambios en las proporciones elementales durante diferentes etapas de desarrollo. Según mediciones métricas, se observó un aumento gradual durante el período de vida. Las medidas métricas del hueso del cráneo tuvieron un valor de medición más alto en los cobayos machos que en las hembras. Mientras que la relación Ca/P aumentó hasta el tercer grupo y disminuyó parcialmente en el cuarto grupo en los machos y aumentó gradualmente del primer grupo al cuarto grupo en las hembras. Este estudio reveló que la pubertad, la edad adulta y el sexo fueron efectivos en la caracterización física y química de la estructura ósea del cráneo en cobayos.

Fibrina rica en plaquetas y leucocitos en abordajes endonasales endoscópicos

Introducción: La medicina regenerativa y terapia celular representa una alternativa segura y eficaz en la regeneración hística. La fibrina rica en plaquetas y leucocitos favorece la cicatrización de la base craneal, con una disminución significativa en las complicaciones, en especial la fístula de líquido cefalorraquídeo. Objetivo: Describir los resultados del empleo de la fibrina rica en plaquetas y leucocitos como elemento accesorio en la reparación de la base craneal. Métodos: Se realizó un estudio descriptivo, transversal en 250 pacientes en el Hospital Hermanos Ameijeiras, operados por procedimientos endonasales endoscópicos con diversos tumores de la base craneal, en los cuales se empleó la fibrina rica en plaquetas y leucocitos durante la fase de reconstrucción. Se realizó una evaluación de la barra de reparación y las complicaciones presentes. Para el análisis de los datos se utilizaron frecuencias absolutas y relativas como medidas resumen. Resultados: El 97,2 % de las barreras de reparación fue catalogada de óptima. Se reporta con el uso de la fibrina rica en plaquetas y leucocitos 2,0 % de fístula de líquido cefalorraquídeo, 0,8 % de infección del sistema nervioso central, 4,0 % de costras nasales posoperatorias. Conclusiones: El presente estudio evidencia el efecto positivo del empleo de la fibrina rica en plaquetas y leucocitos en la reparación del base craneal con gran impacto en el índice de fístula de líquido cefalorraquídeo y la calidad de vida nasosinusal.

Introduction: Regenerative medicine and cell therapy represents a safe and effective alternative in tissue regeneration. Fibrin rich in platelets and leukocytes promotes healing of the cranial base, with a significant decrease in complications, especially cerebrospinal fluid leak. Objective: Describe the results of using fibrin rich in platelets and leukocytes as an accessory element in the repair of the cranial base. Methods: A descriptive, cross-sectional study was carried out in 250 patients at the "Hermanos Ameijeiras" Hospital operated by endoscopic endonasal procedures with various tumors of the cranial base, in which fibrin rich in platelets and leukocytes was used during the reconstruction phase. An evaluation of the repair bar and the complications present was performed. For data analysis, absolute and relative frequencies were used as summary measures. Results: 97.2% of the repair barriers were classified as optimal. With the use of fibrin rich in platelets and leukocytes, 2.0% of cerebrospinal fluid leak, 0.8% of central nervous system infection, 4.0% of postoperative nasal scabs are reported. Conclusions: The present study evidences the positive effect of the use of leukocyte-platelet-rich fibrin in the repair of the skull cranial base, with great impact on the rate of cerebrospinal fluid leak and sinonasal quality of life.

Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo / Frequency of Ponticulus posticus in Digital Lateral Cephalograms

En el arco posterior del atlas se describe una variación de tejido óseo denominada Ponticulus posticus (PP), la cual se ha relacionado con el desarrollo de dolor cervical. El objetivo de este estudio fue determinar la frecuencia de PP en telerradiografías laterales digitales. Este estudio correspondió a un estudio observacional descriptivo, donde se analizaron 450 telerradiografías laterales digitales obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Se analizó la presencia de PP en cada cefalograma, y se utilizó la clasificación de Cederberg y Stubbs para determinar los grados de osificación. Se aplicó la prueba de Chi-cuadrado para establecer una asociación entre la presencia de PP con el sexo y la edad. De las 450 telerradiografías laterales el 42,4 % presenta PP, con una mayor prevalencia entre el rango de 21-40 años. En cuanto al grado de osificación, el grado 2 fue el tipo más prevalente (25 %), seguido del grado 4 (9,5 %), el grado 3 (8 %). No se encontró asociación entre la presencia de PP con edad y género (P > 0,05). La PP es frecuente en la población y se observa a diferentes edades sin predilección por sexo.

SUMMARY: A bony tissue variation called Ponticulus posticus (PP) is described in the posterior arch of the atlas, which has been associated with the development of cervical pain. The aim of this study was to determine the frequency of PP in digital lateral cephalograms. This study was an observational descriptive study, in which 450 digital lateral cephalograms obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile, were analyzed. The presence of PP was analyzed in each cephalogram, and the Cederberg and Stubbs classification was used to determine the degrees of ossification. The Chi-square test was applied to establish an association between the presence of PP with gender and age. Of the 450 lateral cephalograms, 42.4 % presented PP, with a higher prevalence in the 21-40 year range. In terms of the degree of ossification, grade 2 was the most prevalent type (25 %), followed by grade 4 (9.5 %), and grade 3 (8 %). No association was found between the presence of PP with age and gender (P > 0.05). PP is common in the population and is observed at different ages without a sex preference.

Effect of dura mater on enhancement of cranial osteogenesis in rats / 中国组织工程研究

BACKGROUND:The dura mater and skull are physically and functionally related,although there have been few investigations on primary extraction of dura mater and cranial cells,as well as co-culture of the two.The use of primary cells to investigate the influence of the dura mater on the skull is novel,and it is hoped that it may give a theoretical foundation for therapeutic therapy. OBJECTIVE:Rat dura mater and cranial bone cells were retrieved in situ to observe the influence of dura mater on cranial bone proliferation and differentiation,as well as to get a basic knowledge of the involvement of Twist1 in this process. METHODS:The enzyme digestion method was used in conjunction with the tissue block method to extract dural cells and cranial osteoblasts from rats within three days of birth.Immunofluorescence staining was used to identify the extracted cells,and alizarin red staining was used to identify and evaluate cranial osteoblasts and their mineralization ability.After co-culturing dural cells and cranial osteoblasts,real-time PCR was utilized to identify the expression of genes associated to cranial osteoblast proliferation and osteogenesis,as well as Twist1. RESULTS AND CONCLUSION:(1)Morphology:The retrieved dural cells had morphological traits similar to fibroblasts,while the osteoblasts were spindle-shaped.(2)Cell identification:immunofluorescence staining revealed that extracted dural cells expressed high levels of vimentin and cranial osteoblasts expressed high levels of alkaline phosphatase;cranial osteoblasts were stained with alizarin red 28 days after osteogenic induction,and obvious mineralized nodules were observed.(3)Real time PCR detection showed that the co-culture group had higher levels of PCNA,alkaline phosphatase,and RUNX2 mRNA expression than the control group(P＜0.01);however,Twist1 mRNA expression was lower(P＜0.01).(4)The findings showed that the primary extracted cranial osteoblasts had a high mineralization capacity,and that the dura mater was a key factor in promoting cranial growth and development and osteogenic differentiation,with Twist1 playing a key role in this process.

A rare case of anterior skull base metastasis secondary to follicular thyroid carcinoma: A systematic review and illustrative case / Health Sciences Journal

Introduction@#Skull base metastasis from follicular thyroid carcinoma (FTC) is uncommon, with an incidence of 2.5%. Presented here is a case of a 63-year-old female presenting with a 2-year history of progressive left eye proptosis, with a previous history of thyroid surgery for non-toxic goiter. Imaging findings were uncharacteristic of any common skull base tumor. Biopsy revealed follicular thyroid carcinoma. The authors used this case as basis and performed an analysis on available literature for FTC skull base metastasis to help guide management of future cases.@*Methods@#Using PRISMA guidelines, a systematic search across PubMed, Google Scholar, and Cochrane Library using MeSH keywords “Skull base,” “Metastasis,” and “Follicular Thyroid Carcinoma,” identified 18 records. After screening, 15 articles assessed for eligibility, with 8 studies meeting inclusion criteria for qualitative analysis.@*Results@#Studies showcased a consistent age range (43 to 69 years) among patients diagnosed with FTC. Presentation varied depending on tumor location, with symptoms such as dysphagia, proptosis, epistaxis, facial dysesthesia, and visual impairment. Tumor size ranged from 3cm x 3cm x 2cm to 6.8cm x 3.9cm x 5.3cm, influencing management strategies ranging from simple biopsy to sub-temporal complete excision. Adjuvant therapies included combinations of intensity-modulated radiation therapy (IMRT) with immunotherapy, multiple courses of I-131 therapy, oral radioiodine ablation, and radiotherapy, with outcomes showing improvement in most cases. Follow-up duration varied from 12 to 60 months.@*Conclusion@#FTC skull base metastasis remains to be an uncommon entity in neurosurgery. Its rarity creates a lack of established guidelines and treatment algorithms. A high index of suspicion as well as good history and physical examination skills are necessary to achieve an adequate diagnosis. Multidisciplinary teams form the cornerstone of a patient-tailored approach to its management.

3D printed Mg-incorporated polycaprolactone scaffolds for repairing rat skull defects / 口腔疾病防治

Objective@#To evaluate the bone repair effect of 3D-printed magnesium (Mg)-loaded polycaprolactone (PCL) scaffolds in a rat skull defect model.@*Methods@#PCL scaffolds mixed with Mg microparticles were prepared by using 3D printing technology, as were pure PCL scaffolds. The surface morphologies of the two scaffolds were observed by scanning electron microscopy (SEM), and the surface elemental composition was analyzed via energy dispersive spectroscopy (EDS). The physical properties of the scaffolds were characterized through contact angle measurements and an electronic universal testing machine. This study has been reviewed and approved by the Ethics Committee. A critical size defect model was established in the skull of 15 Sprague-Dawley (SD) rats, which were divided into the PCL group, PCL-Mg group, and untreated group, with 5 rats in each group. Micro-CT scanning was performed to detect and analyze skull defect healing at 4 and 8 weeks after surgery, and samples from the skull defect area and major organs of the rats were obtained for histological staining at 8 weeks after surgery.@*Results@#The scaffolds had a pore size of (480 ± 25) μm, a fiber diameter of (300 ± 25) μm, and a porosity of approximately 66%. The PCL-Mg scaffolds contained 1.0 At% Mg, indicating successful incorporation of Mg microparticles. The contact angle of the PCL-Mg scaffolds was 68.97° ± 1.39°, indicating improved wettability compared to that of pure PCL scaffolds. Additionally, compared with that of pure PCL scaffolds, the compressive modulus of the PCL-Mg scaffolds was (57.37 ± 8.33) MPa, demonstrating enhanced strength. The PCL-Mg group exhibited the best bone formation behavior in the skull defect area compared with the control group and PCL group at 4 and 8 weeks after surgery. Moreover, quantitative parameters, such as bone volume (BV), bone volume/total volume (BV/TV), bone surface (BS), bone surface/total volume (BS/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and bone mineral density (BMD), of skull defects were better than those in the other groups, indicating the best bone regeneration effect. H&E, Goldner, and VG staining revealed more mineralized new bone formation in the PCL-Mg group than in the other groups, and H&E staining of the major organs revealed good biosafety of the material.@*Conclusion@#PCL-Mg scaffolds can promote the repair of bone defects and have clinical potential as a new scaffold material for the repair of maxillofacial bone defects.

A Case of Palliative Radiotherapy for Headache Due to Postoperative Skull Metastasis of Pancreatic Cancer

Introduction: Pancreatic cancer often recurs as local recurrence or peritoneal dissemination, causing severe abdominal and back pain. We report a case of postoperative skull metastasis of pancreatic cancer that caused headache and was treated effectively with radiotherapy. Case: A 67-year-old woman underwent surgery for pancreatic cancer. She had epigastric pain due to local recurrence and peritoneal dissemination, which was controlled with loxoprofen and fentanyl transdermal patch. She had right-sided headache, which gradually increased in intensity, but lacked intracranial hypertension and focal neurological symptoms. Acetaminophen and Goreisan did not provide adequate pain relief. Although CT showed no brain or bone metastasis, MRI showed metastasis in the right frontal bone. Palliative radiotherapy was administered. Subsequently, headache decreased from 7–8/10 to 2–3/10 on the Numerical Rating Scale. Conclusion: Skull metastases in cancer patients may be diagnosed using MRI, even when they remain undetectable by CT.

Endoscopic Study of Ethmoidal Canals in Cadavers, Including a Histological Analysis of Their Contents

Abstract Introduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull. Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents. Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis. Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel. Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.

Asymmetry of the anterior ethmoidal artery in relation to the anterior skull base: a population-based study of 500 arteries

Abstract Objective To analyze variability in the distance between the Anterior Ethmoidal Artery (AEA) and the anterior Skull Base (SB), as well as the frequency of lateral asymmetry in a Latin American population using computed tomography. Methods A total of 250 computed tomography scans of paranasal sinuses in coronal reconstruction (500 AEAs) were analyzed. After determining the image with the best anatomical view of the artery, the distance between its midpoint and the ethmoidal roof was measured, and the images were independently interpreted by 2 physicians. Results Of the 500 AEAs, 279 (55.8%) adhered to or passed through the SB at a distance of 0 mm. A total of 221 AEAs (44.2%) were at some distance from the SB, of which 107 (48.4%) were on the right side, ranging from 1.18 to 6.75 mm, and 114 (51.5%) were on the left side, ranging from 1.15 to 6.04 mm. The overall mean distance between the AEA and SB was 1.22 (SD = 1.57) mm, increasing to 2.77 (SD = 1.14) when the arteries adhered to the SB were excluded. Seventy-six individuals (30.4%) had a lateral distance variation > 1 mm. Conclusion Our study includes the largest sample of AEA analyzed with computed tomography scans of paranasal sinuses. There was some distance between the AEA and SB in almost half the patients, and we found a high rate of lateral variability >1 mm. Level of evidence: Level 3.

Evaluation of sinonasal-related quality of life of 49 patients undergoing endoscopic skull base surgery

Abstract Objective This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery. Methods A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment. Results Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD = 5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p < 0.05), while the ENS6Q score was not. Conclusions The possibility of patients suffering from ENS after nasal endoscopic skull base surgery is at a low level, although the nasal cavity structure is damaged to varying degrees. Meanwhile, patients undergoing endoscopic skull base surgery were likely to suffer nasal problems and sleep disorders. Patients who had received radiotherapy have a worse QoL than those without a history of radiotherapy. Level of evidence Level 3.

Barrera de reparación de la base craneal en los abordajes endonasales endoscópicos / Skull base reconstruction barrier in endoscopic endonasal approaches

Introducción: Los abordajes endonasales endoscópicos son los procedimientos de elección para tumores mediales en la base craneal por su seguridad y efectividad. La reparación de la base craneal constituye un elevado desafío. Objetivo: Evaluar la efectividad de la construcción de una barrera de reconstrucción de la base craneal en pacientes con tumores de la base craneal operados por procedimientos endonasales endoscópicos. Método: Se realizó un estudio descriptivo, que incluyó a 70 pacientes del Hospital Hermanos Ameijeiras operados de tumores de la base craneal por procedimientos endonasales endoscópicos. Se construyó una barrera de reparación de la base craneal para aislar el compartimiento nasosinusal del intracraneal. Se determinó la eficiencia de la barrera de reparación mediante aspectos clínicos y endoscópicos. Se definieron aspectos a evaluar en relación con la vitalidad de la barrera de reparación con el empleo de la fibrina rica en plaquetas y leucocitos. Resultados: Se evidenció una barrera de reparación eficiente en el 98,6 por ciento. En relación con estado de vitalidad de la barrera se apreció una adherencia, granulación en el 98,6 por ciento de pacientes, mientras una angiogénesis de 97,1 por ciento. La incidencia de fístula de líquido cefalorraquídeo posoperatoria fue de solo 1,4 por ciento. Conclusiones: El presente estudio evidencia el efecto positivo de la construcción de una barrera de reparación eficiente de la base craneal por vía endonasal endoscópica con disminución significativa de fístula de líquido cefalorraquídeo y sus complicaciones(AU)

Introduction: Endoscopic endonasal approaches are the procedures of choice for medial tumors in the cranial base given their safety and effectiveness. Repair of the cranial base constitutes a high challenge. Objective: To evaluate the effectiveness of constructing a cranial base reconstruction barrier in patients with cranial base tumors operated on by endoscopic endonasal approaches. Method: A descriptive study was carried out, which included 70 patients from the Hermanos Ameijeiras Hospital operated on for cranial base tumors using endoscopic endonasal approaches. A cranial base repair barrier was constructed to isolate the sinonasal and intracranial compartments. The efficiency of the repair barrier was determined through clinical and endoscopic aspects. Aspects were defined to be evaluated in relation to the vitality of the repair barrier with the use of fibrin rich in platelets and leukocytes. Results: An efficient repair barrier was evident in 98.6 percent. In relation to the state of vitality of the barrier, adhesion and granulation were observed in 98.6 percent of patients, while angiogenesis was observed in 97.1 percent. The incidence of postoperative cerebrospinal fluid leak was only 1.4 percent. Conclusions: The present study shows the positive effect of the construction of an efficient repair barrier of the cranial base in endoscopic endonasal approaches with a significant reduction in cerebrospinal fluid leak and its complications(AU)

Manejo neuroquirúrgico de absceso epidural post traumatismo craneoencefálico: a propósito de un caso / Neurosurgical management of epidural abscess after traumatic brain injury: a case report

RESUMEN El traumatismo craneoencefálico es un evento ocasionado por la fuerza sobre el continente que guarda al contenido cerebral, que hace que la inercia ocasione lesiones por aceleración y desaceleración produciendo hemorragias y/o fracturas Estas pueden generar una serie de complicaciones como el absceso epidural que al estar muy cerca al cerebro constituye una emergencia, siendo complejo su manejo y seguimiento. En esta oportunidad mostramos el caso de un paciente con absceso epidural ocasionado por traumatismo craneoencefálico y manejo neuroquirúrgico, con buena evolución clínica.

ABSTRACT Cranioencephalic trauma is an event caused by force on the container that holds the brain content, which causes inertia to cause acceleration and deceleration injuries, producing hemorrhages and/or fractures; These can generate a series of complications such as epidural abscess which, being very close to the brain, constitutes an emergency for its management and follow-up15. On this occasion we show the case of a patient with epidural abscess caused by cranioencephalic trauma and neurosurgical management.

Nasal Crust-Related Morbidity and Debridement After Endoscopic Skull Base Surgery

Abstract Introduction: Nasal crust after endoscopic skull base surgery can cause nasal congestion, obstruction, and pain, which can affect quality of life. The use of debridement aims to provide symptomatic relief and improve quality of life. Generally, most adult patients tolerate office-based debridement, except in a few select patients that require further sedation in the operating room for a debridement. The study sought to determine the rate of symptomatic crust-related morbidity and the rate of debridement in both the office and the operating room. Methods: Premorbid, operative, and postoperative data of adult patients who had endoscopic skull base surgery in our institution from 2014 to 2018 were reviewed retrospectively. The characteristics of nasal symptoms in the postoperative period were determined and the numberofdebridementsin theoffice and the operatingroomwere analyzed. Results: Two hundred and thirty-four (234) patients with 244 surgeries were included in the study. The majority, 68.9%, had a sellar lesion and a free mucosa graft (FMG) was the most common skull base reconstruction at 53.5%. One hundred and twenty (49.0%) had crust-related symptoms during the postoperative period and 11 patients (4.5%) required the operating room for debridement. The use of a pedicled flap, anxiety, and preoperative radiotherapy were significantly associated with intolerance to in-office debridement (p-value=0.05). Conclusions: The use of a pedicled flap or anxiety may predispose patients to require an OR debridement. Previous radiotherapy also influenced the tolerance to the in-office debridement.

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.

The Discovery of a Bone in the Anterior Fontanelle of the Skull of the Sheep (Ovis aries) / Descubrimiento de un Hueso en la Fontanela Anterior del Cráneo de la Oveja (Ovis aries)

SUMMARY: A comparative study of the skull morphology was conducted using 270 prenatal and 750 postnatal skull samples from three breeds of sheep in Nigeria namely, Balami, Uda and Yankasa. A unique bone peculiar to the Yankasa breeds of sheep was found consistently at the centre of the anterior fontanelle in the young (day-old to 1 year). At two years of age and above, the bone was fused and disappeared completely. This brings the total numbers of the neurocranium bones of the skull in the Yankasa breeds to 8, as against the 7 bones documented in the ovine species. Due to the fact that this bone has not been described in the literature, we venture to name it the anterio-fontanelle bone (of Atabo).

Se realizó un estudio comparativo de la morfología del cráneo utilizando 270 muestras de cráneos prenatales y 750 postnatales de tres razas de ovejas en Nigeria, Balami, Uda y Yankasa. Un hueso único peculiar de las razas de ovejas Yankasa se encontró consistentemente en el centro de la fontanela anterior en las crías (de un día a 1 año). A los dos años de edad o más, el hueso se fusionó y desapareció por completo. Esto eleva el número total de huesos del neurocráneo en el cráneo en las razas Yankasa a 8, frente a los 7 huesos documentados en la especie ovina. Debido a que este hueso no ha sido descrito en la literatura, nos aventuramos a denominarlo hueso antero-fontanela (de Atabo).

Cranioplastia frontal com enxerto de parede anterior de seio frontal e retalho pericrânio têmporo-parietal: relato de caso / Frontal cranioplasty with bone graft from the anterior wall of the frontal sinus and temporo-parietal pericranium flap: case report

O osso frontal integrante do esqueleto craniano e que integra o terço superior da face, tem papel importante na proteção do conteúdo encefálico. Fazendo parte dessa referência, encontra-se uma cavidade sinusal de dimensões variáveis, o seio frontal. A localização anatômica do seio frontal permite que ele contribua para proteção do lobo frontal agindo como barreira absorvedora de choque, além da fisiologia sinusal. As fraturas craniofaciais podem afetar a parede anterior e/ou posterior, com ou sem envolvimento do ducto nasofrontal (DNF). O planejamento do tratamento é baseado na relação clínico-imaginológica. A tomografia computadorizada (TC) tem grande importância no processo decisório do planejamento. O tratamento pode ser do tipo não cirúrgico, quando há patência dos DNF e comprometimento estético não crítico para o paciente, ou cirúrgico quando há comprometimento dos DNF e/ou comprometimento estético crítico, ou ainda quando há envolvimento da parede posterior e necessidade de cranialização e obliteração ductal. O objetivo deste artigo é relatar uma cranioplastia secundária à sequela de fratura fronto-orbitária, com emprego de fragmentos osteotomizados do próprio sítio de fratura, fixados com miniplacas do Sistema 1.5mm e ainda o emprego de retalho de pericrânio têmporo-parietal para camuflagem de tecido mole por preenchimento.

The frontal bone, part of the cranial skeleton and part of the upper third of the face has an essential role in protecting brain content. As part of this reference, there is a sinus cavity of variable dimensions, the frontal sinus. The anatomical location of the frontal sinus allows it to contribute to frontal lobe protection by acting as a shock-absorbing barrier in addition to sinus physiology. Craniofacial fractures can compromise the anterior and(or) posterior wall, with or without the involvement of the nasofrontal duct (NFD). Treatment planning is based on clinical and imaging evaluation. Computed tomography (CT) is essential for planning and decision-making process. The treatment can be non-surgical, when there is patency of the FND and aesthetic impairment that is not critical for the patient, or surgical when there is impairment of the FND and/or critical aesthetic impairment, or even when there is involvement of the posterior wall and the need for cranialization and ductal obliteration. The objective of this article is to report a cranioplasty secondary to the sequelae of a frontal-orbital fracture, using osteotomized fragments from the fracture site itself, fixed with miniplates (1.5mm System), and the use of a temporoparietal pericranium flap to camouflage tissue soft for filling.

Sex estimation based on foramen magnum: a three-dimensional geometric morphometrics approach / Estimación del sexo basado en el foramen magno: un enfoque de morfometría geométrica tridimensional

SUMMARY: The foramen magnum is an important topographic opening which connects cranial cavity and spinal canal. The analysis of the bone material established that there are differences in the shape of the foramen magnum between individuals. The aim of this study was to determine sex based on shape and size of foramen magnum using geometric morphometrics method. A study was performed on three-dimensional models (3D models) of 214 human skulls of known sex and known age (141 male skulls and 73 female skulls). The skulls are located at the museum of Medical Faculty, University of Sarajevo. Skulls belong to Bosnian population from the mid-twentieth century. All examined skulls were scanned with a laser scanner to obtain their 3D models. On 3D models of the examined skulls, four landmarks were marked on foramen magnum. Analysis of sex determination was performed using the MorphoJ program. Results of this study showed that there are sex differences in the shape and size of the foramen magnum. Sex determination based on the shape and size of the foramen magnum was showed 65.25 % accuracy for male and 63.01 % accuracy for female using geometric morphometrics method. Examination of the effect of size of foramen magnum on sexual dimorphism of shape of foramen magnum showed a statistically significant effect. Sex determination based just on the shape of foramen magnum using geometric morphometrics method was possible with 62.41 % accuracy for male and 58.90 % accuracy for female on examined sample. Sex differences on shape and size of foramen magnum were found using geometric morphometrics method on three-dimensional models of the examined skulls. The percentage of accuracy was higher for male based on the shape and size of the foramen magnum than for female.

El foramen magno es una importante abertura topográfica que conecta la cavidad craneal y el canal espinal. El análisis del material óseo estableció que existen diferencias en la forma del foramen magno entre individuos. El objetivo de este estudio fue determinar el sexo en función de la forma y el tamaño del foramen magno utilizando morfometría geométrica. El estudio se realizó en modelos tridimensionales (modelos 3D) de 214 cráneos humanos de sexo y edad conocidos (141 cráneos masculinos y 73 cráneos femeninos). Los cráneos se encuentran en el museo de la Facultad de Medicina de la Universidad de Sarajevo. Los cráneos pertenecen a población bosnia de mediados del siglo XX. Todos los cráneos examinados fueron escaneados con un escáner láser para obtener sus modelos 3D. En los modelos 3D de los cráneos examinados, se marcaron cuatro puntos de referencia en el foramen magno. El análisis de determinación de sexo se realizó utilizando el programa MorphoJ. Los resultados de este estudio mostraron que existen diferencias de sexo en la forma y el tamaño del foramen magno. La determinación del sexo basada en la forma y el tamaño del foramen magno mostró una precisión del 65,25 % para los hombres y del 63,01 % para las mujeres utilizando morfometría geométrica. El examen del efecto del tamaño del foramen magno sobre el dimorfismo sexual de la forma del foramen magno mostró un efecto estadísticamente significativo. La determinación del sexo basada solo en la forma del foramen magno utilizando morfometría geométrica fue posible con una precisión del 62,41 % para los hombres y del 58,90 % para las mujeres en la muestra examinada. Se encontraron diferencias de sexo en la forma y el tamaño del foramen magno utilizando morfometría geométrica en modelos tridimensionales de los cráneos examinados. El porcentaje de precisión fue mayor para los hombres en función de la forma y el tamaño del foramen magno que para las mujeres.

Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles / Perfusão por ressonância magnética em schwannoma vestibular: influência do tamanho e estádio cístico no perfil da perfusão

Abstract Objective: The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods: Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)—the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)—as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results: Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion: In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.

Resumo Objetivo: O perfil de perfusão do schwannoma vestibular (SV) não tem sido estudado, nem os fatores que o influenciam. Materiais e Métodos: Vinte pacientes com SV esporádico foram analisados usando Ktrans, Ve, Kep e rCBV e correlacionados com tamanho e estádio cístico. Resultados: Ktrans, Ve e Kep foram medidos em todos os casos. rCBV só foi possível em tumores grandes. Ktrans e rCBV estavam correlacionados positivamente (r = 0,62, p = 0, 0 31 ) . Ve e Kep estavam negativamente correlacionados (r = -0,51, p = 0,021). Ktrans estava correlacionado positivamente com Ve em SVs sólidos (r = 0,64, p = 0,048). Em SVs pequenos, Ktrans foi menor (0,13 vs 0,029, p < 0,001), Kep foi maior (0,68 vs 0,46, p = 0,037) e Ve foi menor (0,45 vs 0,83, p < 0,001) que nos SVs grandes. Ktrans e Ve foram menores dentro dos cistos que nas porções solidas dos SVs císticos (0,14 vs 0,32, p < 0,001; 0,37 vs 0,78, p < 0.001, respectivamente). Foi encontrada correlação positiva em Ktrans (r = 0,71, p = 0,048) e Kep (r = 0,74, p = 0,037) entre as áreas sólidas e císticas. Conclusão: Nos SVs, o tamanho está consistentemente associado com os valores da perfusão. Nos SVs císticos, as porções císticas parecem ter valores menores de Ktrans e Ve do que nas porções sólidas.