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.

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.

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.

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).

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.

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.

Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses / Alterações angiográficas e histopatológicas agudas e crônicas da rete mirabile no modelo suíno com sistema embólico líquido Menox

Abstract Objective: To evaluate acute and chronic changes seen on angiographic and histopathological studies of porcine rete mirabile, comparing those treated with the Menox liquid embolic system (LES) and those treated with the Onyx LES. Materials and Methods: Five pigs, each weighing approximately 35 kg, were submitted to rete mirabile embolization under general anesthesia and fluoroscopic guidance, with the Menox LES or Onyx LES. Four animals were treated with the Menox LES and underwent cerebral angiography, followed by euthanasia, at 1, 30, 60, and 90 days after embolization. One animal was treated with the Onyx LES underwent the same procedures at 30 days after embolization. In a subsequent histopathological analysis, we compared the Menox LES and Onyx LES in terms of the acute and chronic changes observed. Results: We observed no significant changes in blood pressure, heart rate, or electrocardiographic parameters that could be attributed to the super-selective infusion of dimethyl sulfoxide or the Menox embolic agent. Fluoroscopy showed adequate material opacity, appropriate progression to the center of the rete mirabile and complete unilateral embolization. Microcatheters were uneventfully detached from the embolized nidus. We observed mild to moderate intravascular and extravascular inflammatory responses, without histological evidence of necrotizing arteritis. There were no adverse neurovascular events. Conclusion: The Menox LES appears to be safe and effective, as well as being apparently equivalent to the Onyx LES in terms of the postprocedure angiographic and histopathological findings.

Resumo Objetivo: Avaliar as alterações angiográficas e histopatológicas agudas e crônicas em rete mirabile suína tratadas com o Menox liquid embolic system (LES) e comparar essas alterações com a embolização com Onyx LES. Materiais e Métodos: A embolização da rete mirabile com Menox LES e Onyx LES foi realizada em cinco suínos pesando cerca de 35 kg sob anestesia geral e orientação fluoroscópica. Quatro animais tratados com Menox LES foram submetidos a angiografia cerebral seguida de eutanásia após 1, 30, 60 e 90 dias e um animal tratado com Onix LES foi submetido ao mesmo procedimento após 30 dias. A análise histopatológica subsequente para alterações agudas e crônicas avaliou o desempenho do Menox LES comparado ao Onyx LES. Resultados: Não foram observadas alterações significativas atribuíveis à infusão superseletiva de dimetilsulfóxido ou Menox nos parâmetros de pressão arterial, frequência cardíaca ou eletrocardiograma. A fluoroscopia mostrou opacidade adequada do material, progressão adequada para o centro da rete mirabile e embolização unilateral completa. Os microcateteres foram retirados do nidus embolizado sem complicações. Observou-se resposta inflamatória intravascular e extravascular leve a moderada, sem indício histológico de arterite necrosante. Nenhum dos casos apresentou eventos neurovasculares adversos. Conclusão: A injeção de Menox LES mostrou-se segura e eficaz, além de ser equivalente ao Onyx LES em relação aos achados angiográficos e histopatológicos pós-procedimento.

Ultrasound fusion navigation-guided core needle biopsy for lesions involved the parapharyngeal space, infratemporal fossa, and skull base: a pilot study / 中华超声影像学杂志

Objective:To explore the value of ultrasound fusion navigation technology in the biopsy of parapharyngeal-infratemporal fossa-skull base (PIS) lesions.Methods:This study was conducted at the First Affiliated Hospital of Sun Yat-Sen University from March 2021 to March 2022 and included 8 patients [3 females and 5 males; age, (50±20) years; range, 16-76 years] with PIS lesions who needed to clarify the pathological diagnosis. The ultrasound fusion navigation with CT or MRI was used to guide lesion biopsy, and the technical feasibility, pathological diagnostic results and complications were evaluated.Results:The biopsy procedures were successful in all 8 patients, and the lesion size ranged from 2.2 to 6.5 cm. The exact pathological diagnosis was obtained in 7 patients, and the diagnostic rate was 87.5% (7/8). No major complication was observed after the biopsy. Mild complications occurred in 1 case, with a incidence of 12.5% (1/8).Conclusions:Ultrasound fusion navigation-guided biopsy is feasible, effective, and safe in the biopsy of deep head and neck lesions.

Effect of the multidisciplinary diagnosis and treatment nursing on postoperative psychological state and quality of life in patients with lateral skull base tumor / 中国实用护理杂志

Objective:To explore the application effect of the multidisciplinary diagnosis and treatment nursing in improving postoperative anxiety and depression and quality of life in patients with lateral skull base tumor, so as to provide a constructive template for the multidisciplinary diagnosis and treatment nursing.Methods:This was a prospective cohort study design. A total of 100 patients who underwent lateral skull base tumor surgery in Shandong Second Provincial General Hospital from January 2021 to April 2022 were selected as the research objects. The patients were divided into observation group and control group by random digits table method with 50 cases in each group. The control group was given routine nursing care after operation of lateral skull base tumor and routine follow-up management. The observation group received the multidisciplinary diagnosis and treatment nursing on the basis of the control group. The intervention time was 3 months. The psychological state and quality of life of the two groups before and after intervention were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form Health Questionnaire (SF-36).Results:There was no significant difference in SAS, SDS, and SF-36 scores before intervention between the two groups ( P>0.05). The scores of SAS, SDS and SF-36 after the intervention were (44.58 ± 5.61), (41.66 ± 8.48), (75.66 ± 13.65) points in the observation group, and (50.86 ± 4.91), (45.80 ± 9.32), (68.43 ± 14.34) points in the control group, there were statistically significant differences between the two groups( t values were -5.95, -2.32, 2.58, all P<0.05). Conclusions:The multidisciplinary diagnosis and treatment nursing can significantly improve anxiety, depression and quality of life of patients with lateral skull base tumor after surgery.

Occurrence of hypopituitarism after severe craniocerebral trauma and its predictors / 中华内分泌外科杂志

Objective:To investigate the occurrence and predictors of hypopituitarism after traumatic brain injury (TBI) .Methods:A prospective study was conducted on 185 patients with severe TBI in the Emergency Department of the First Hospital of Shanxi Medical University from Jan. 2020 to May. 2022, of whom 108 were male and 77 were female; age ranged from 18 to 79 years, mean (51.32±9.34) years. Pituitary function was assessed within 3-7 d after the onset of TBI, and the occurrence of hypopituitarism after severe TBI was counted. 41 cases in the hypopituitarism group, 26 males and 15 females, aged (52.76±9.83) years, were divided into the hypopituitarism group (hypopituitarism occurred) and the non-hypopituitarism group (hypopituitarism did not occur) according to whether hypopituitarism occurred. In the non-decompensated group, there were 144 cases, 82 males and 62 females, aged (50.91±9.27) years. The clinical data of the decompensated and non-decompensated groups were compared, and the factors influencing the occurrence of hypopituitarism were analysed, and a logistic prediction model was constructed based on the relevant influencing factors. The value of this model in predicting the occurrence of hypopituitarism after severe TBI was evaluated by using the receiver operating characteristic (ROC) curve.Results:The prevalence of hypopituitarism in the 185 patients with severe TBI in this study was 22.16%; the Glasgow coma scale (GCS) score on admission was lower in the decompensated group than in the non-decompensated group [ (6.36±1.04) vs (7.48±0.59) ], the percentage of hyperbaric oxygen therapy was lower than in the non-decompensated group (21.95% vs 49.31%) , the percentage of intracranial pressure (82.93% vs 49.31%) , midline displacement ≥5 mm (78.05% vs 29.86%) , skull base fracture (34.15% vs. 17.36%) , diffuse cerebral edema (19.51% vs 4.17%) , and serum brain derived neurophic factor (BDNF) . Brain derived neurophic factor (BDNF) was higher than that in the non-reduced group [ (6.35±1.29) ng/ml vs (4.51±1.06) ng/ml], and neuronal-specific enolase (NSE) was higher than that in the non-reduced group [ (33.06±5.42) μg/L vs (23.15±4.97) μg/L]. (4.97) μg/L]. Vascular epithelial growth factor (VEGF) was higher than that in the non-reduced group [ (312.07±24.35) pg/ml vs (226.80±20.96) pg/ml], tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group [ (281.24±38.91) ng/L vs (186.91) pg/ml], and tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group (186.55±35.72) ng/L (all P<0.05) . Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF, and TNF-α levels were all independent risk factors for the development of hypopituitarism after severe TBI, with admission GCS score and hyperbaric oxygen therapy as protective factors ( P<0.05) ; a logistic prediction model was constructed based on the influencing factors as: Logit ( P) = 5.264-0.880×admission GCS score + 1.618×increased intracranial pressure + 1.941×midline displacement ≥5 mm + 1.289×diffuse cerebral edema+1.306×BDNF+1.426×NSE+1.781×VEGF+1.615×TNF-α-0.758×hyperbaric oxygen therapy; the model predicted the occurrence of severe TBI after the area under the curve (AUC) of hypopituitarism was 0.930 (95% CI 0.883-0.962) , with a predictive sensitivity and specificity of 90.24% and 89.19%, respectively. Conclusions:The incidence of hypopituitarism is higher after severe TBI. Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF and TNF-α levels are all used as predictors of hypopituitarism.

Increasing Source-Object Distance: A Computed Radiographybased Strategy to Reducing Radiation Dose in Occipital-Frontal Skull X-Ray

@#Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.

Acupuncture of revised acupoint combination around the skull base for post-stroke mild cognitive impairment: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of acupuncture of revised acupoint combination around the skull base in treating post-stroke mild cognitive impairment (PSMCI), and preliminary explore its action mechanism.@*METHODS@#A total of 76 PSMCI patients were randomly divided into an observation group (38 cases, 4 cases dropped off) and a control group (38 cases, 3 cases dropped off, 1 case was removed). In the observation group, acupuncture of revised acupoint combination around the skull base (bilateral Fengchi [GB 20], Wangu [GB 12], Tianzhu [BL 10] and Yamen [GV 15], Baihui [GV 20]) was used for treatment. In the control group, 8 non-meridian and non-acupoint points at the distal end were selected for shallow puncture treatment. Retaining the needles of 30 min, once every other day,3 times a week for 4 weeks in both groups. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Barthel index (BI) and serum levels of cystatin C (Cys-C) and homocysteine (Hcy) were compared in the two groups before and after treatment, and the clinical efficacy was evaluated.@*RESULTS@#After treatment, the scores of MoCA were increased compared with those before treatment in the two groups (P<0.05), and the score in the observation group was higher than that in the control group (P<0.05). The scores of MMSE and BI were increased compared with those before treatment in the observation group (P<0.05), and the score of MMSE in the observation group was higher than that in the control group (P<0.05). After treatment, the serum levels of Cys-C and Hcy were decreased compared with those before treatment in the observation group (P<0.05), and lower than those in the control group (P<0.05). After treatment, the serum level of Cys-C was increased compared with that before treatment in the control group (P<0.05). The total effective rate of the observation group was 88.2% (30/34), which was higher than 32.4% (11/34) of the control group (P<0.05).@*CONCLUSION@#Acupuncture of revised acupoint combination around the skull base can improve cognitive function and daily living ability of PSMCI patients, which may be related to the down regulation of serum levels of Cys-C and Hcy.

Multi-factor analysis of sellar floor dural suture, bone reconstruction and pedicled nasoseptal flap in skull base reconstruction / 西安交通大学学报(医学版)

【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all PPNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.

Accuracy of 3D printing skull under different CT layer thickness / 解剖学报

Objective To compare the measurement differences between the skull 3D printed model and the real specimen under different CT scan slice thicknesses, and to explore the effect of slice thickness on the accuracy of the 3D printed model. Methods Eight normal skull specimens (marked as Nos. f-8) (group N) were used for CT scanning with different slice thicknesses, specifically 0.625 mm (group A),1.25 mm (group B) , and 2.5mm (group C) ,3.75 mm (group D) , and 5 mm (group E) , and then earned out 3D reconstruction and 3D printing respectively, and compared the anatomical reduction degree of the foramen magnum diameter, anterior clinoid distance, and butterfly wing distance of the 3D printed skull model. Results The reduction degree of anatomical structure of 3D printed skull model decreased with the increase of CT slice thickness. There was no significant difference in the accuracy of 3D model among groups A, B and C (P >0.05 ) . There was a high correlation between group A, B and C and group N ( P < 0 .05 ).The size indexes and statistical values of group A, B and C were similar. Conclusion CT slice thickness has a significant effect on the accuracy and reduction of the 3D printed skull model. The 3D printed model with thin slice data (0.625 mm,1.25 mm,2.5 mm) has higher accuracy and less difference.

Application of multimodal electromagnetic navigation in endoscopic endonasal skull base anatomical measurement of fresh cadavers / 解剖学报

Objective Electromagnetic navigation was used to observe and measure important anatomical structures through endoscopic endoscopic approach (EEA) to the ventral skull base to provide data for clinical surgery. Methods Using electromagnetic navigation to measure the anatomical structure of the central and paracentral ventral skull base on 10 fresh cadavers, the internal carotid artery (ICA) was the most important. Results Electromagnetic navigation helped to determine the course of important neurovascular. The ICA of the ventral skull base was divided into 5 segments+ 7 major branches, and the length and course of each were measured and recorded. Conclusion The identification and protection of ICA is the key to EEA treatment of ventral skull base lesions, and electromagnetic navigation assistance can improve the efficiency and safety of EEA surgery.

Research progress of necrotizing otitis externa / 临床耳鼻咽喉头颈外科杂志

Necrotizing otitis externa is a progressive infectious disease involving the external auditory canal and even the skull base, which can lead to serious complications and even death if not treated in time. In this paper, the latest advances in etiology, pathogenesis, clinical manifestations, diagnosis and treatment were reviewed based on previous literature, providing reference for clinical diagnosis, treatment and future research.

Assessment of americium retention in bone by measuring 241Am in the skull with a whole-body counter / 中国辐射卫生

Objective To assess the retention of 241Am in the whole-body bone of worker by measuring the retention of 241Am in the skull. Methods A whole-body counter with high-purity germanium detector was used to measure the 59.5 keV full-energy peak count of 241Am in the skull. The efficiency of the measurement was calibrated by the digital skull phantom combined with the geometric model of the detector. The retention of 241Am in the worker’s skull was calculated. Results The proportion of skull dry weight relative to the whole-body bone dry weight was used as the coefficient to calculate the 241Am deposition in the whole-body bone from the measured activity of skull 241Am. Conclusion With the retention of 241Am in the skull and the proportion of skull dry weight, the retention of 241Am in the whole-body bone of the worker was calculated to be about 806 Bq.

Current diagnosis and treatment of skull base osteomyelitis / 临床耳鼻咽喉头颈外科杂志

Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.