Radiological and Morphometric Study of the Emissary Foramens and Canal in the Posterior Cranial Fossa of the Human Skull with Its Neurosurgical Significance.

Objective The posterior condylar canals (PCCs), posterior condylar veins (PCVs), occipital foramen (OF), and occipital emissary vein (OEV) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We performed the study to make morphometric and radiological analyses of the various emissary foramens and vein in the posterior cranial fossa. Methods Morphometric study were performed on 95 dry occipital bones and radiological analyses on computed tomography (CT) angiography images of 150 patients. The number of OFs on both sides was recorded and PCC length and mean diameters of the internal and external orifices of PCC were measured for bony specimens. Prevalence of PCV and PCV size was investigated using CT angiography. Results Mean PCC length was higher in the left side (9.85 ± 2.5). Mean diameter of the internal orifice and the external orifice diameter were almost the same. The majority of PCCs (75-79.33%) had 2 to 5 mm diameter; only 4 to 9.2% were small in size (< 2 mm). In CT angiography, PCV was not identified in 23 (15.33%) patients. PCVs were located bilaterally in 105 (70%) and unilaterally in 22 (20.5%) patients. Only 11.3% of PCVs were large in size (> 5 mm), 80% of PCVs were medium sized (2-5 mm), and 8.6% were small sized (< 2 mm). Conclusion Normal values of OF, PCC, PCV, and OEV could serve as a future reference for the understanding of the physiology of craniocervical venous drainage, which is necessary to avoid surgical complications and can also serve as a guide to surgical interventions for pathologies of the posterior cranial fossa, such as tumors and injuries.

Morphometry of organization of middle meningeal artery through the analysis of bony canal in human's skull: A clinico-anatomical and embryological insight.

BACKGROUND: Middle meningeal artery (MMA) is the largest branch of the maxillary artery supplying meninges of the cranial cavity. The complexity of MMA development gives many opportunities for anatomical variation. Besides, the variant MMA can be easily injured when dealing with fractures of the base of the skull, epidural hematomas, and bypass procedures. Although various aberrant origins of the MMA have been documented in the literature, there is a lack of detailed morphometric aspects of this important arterial segment. Thus, in this study, we investigated the anatomical organization of the MMA through the bony canal measurements from human skulls to improve surgical results. MATERIALS AND METHODS: Seventy-five adult dry skulls were investigated. Angle of the main trunk, length of the main trunk, angle between the frontal and parietal branches, length of the frontal branch, length of the parietal branch, and length of the bony tunnel formed by the frontal branch were measured bilaterally. RESULTS: In the present study, we found significant differences between the parameters such as length of frontal (P = 0.034) and parietal (P = 0.023) branches and length of bony tunnel (P = 0.045) of right and left sides, but there was no significant difference found in the rest of the parameters. CONCLUSIONS: Morphometry of the bony canal of MMA shall be important for safely expose and preserve the artery during craniotomy with careful drilling and shall be useful for those who have interest in this anatomical site.

Morphometric and Anatomic Variations of Foramen Ovale in Human Skull and Its Clinical Importance.

OBJECTIVE: There is a paucity of information regarding the specific anatomy and clinical significance of variations of foramen ovale (FO). The present study was undertaken to define this anatomy in more detail and to review the literature regarding these anatomic variations. MATERIALS AND METHODS: A total of 124 adult human dry skulls were analyzed for the variations in appearance and number of FO being noted. The length and width of the FO of both sides were determined using digital vernier calipers and area (A) was also calculated and analyzed. RESULTS: Of 82 adult skulls, the values for the right side was 7.64 ± 1.194 mm, 5.128 ± 0.827 mm, and 30.808 ± 7.545 mm2 and for the left side the values was 7.561 ± 1.123 mm, 5.244 ± 0.950 mm, and 31.310 ± 8.262 mm2, respectively, for the mean length, width, and area of the FO. The shape of foramen was typically ovale in most of the skulls (56.70%) with some bony variations such as spine, tubercles, bony bridge/bar, and confluence. CONCLUSION: Such variants in the FO could interfere with transcutaneous needle placement into the FO or distort anatomic relationships during approaches to the cranial base.

Epidemiological study of burn patients hospitalised at a burns centre, Manipal.

Burn injuries constitute a major public health problem and account for a significant cause of mortality and morbidity amongst the Indian population. This 2-year prospective study was undertaken to find out the exact epidemiological determinants of 737 patients admitted with burn injuries and, thus, to try and formulate effective preventive strategies. This study was conducted in the department of plastic surgery and burns from September 2011 to June 2013. All consecutive patients with major burns admitted for in-hospital treatment during the study period were included in the study. The data collected included age, gender, cause and mode of burns, total burn surface area (TBSA), microbiological profile and outcome. More than 55% of the patients were female (58.61%). The mean age was 31.3 years ranging from 8 months to 89 years. A higher number of females (97.5%) sustained burn injuries at home compared with 36.11% males sustaining injuries outdoors. (P = 0.000). Almost one third of injuries (40.36%) occurred between 4 pm and 8 pm, followed by 28% between 7 am and 12 noon. Synthetic garments were worn by 70% of females at the time of injury, whereas 40% of males had worn mixed clothing (P = 0.000). Flame injuries contributed to 80.1% of burns in females (P = 0.006). The rate of electrical injuries (9.8%) was significantly higher in males (P = 0.005). In almost 40% of males, TBSA was <19%, whereas in 40% of females, TBSA was >68%. (P = 0.004). Microbial profile showed that pseudomonas aeruginosa (n = 260; 35.3%), Klebsiella pneumoniae (n = 209; 28.5%), and Escherichia coli (n = 145; 22.6%) were the most frequent types of Staphylococci bacterial growths. The cause for burn injury was ignition of clothes in 68.74% females, and in 35.48% males, it was because of an attempt to save other burn injury victims (P = 0.013) The case fatality rate was 29.3%. A majority of the males (60.7%) recovered, whereas 45.89% of females succumbed because of their burn injury. (P = 0.001). As the aetiological factors of burn injuries vary considerably in different communities, careful study of the pattern in every community is needed before a sound prevention programme can be planned and implemented. Hence, this study was conducted to assess epidemiological, modes, causes, and risk factors and the microbial profile of burn injuries and to study the outcomes.

Superficial Burn Wound Healing with Intermittent Negative Pressure Wound Therapy Under Limited Access and Conventional Dressings.

BACKGROUND: Thermal injury is associated with several biochemical and histopathological alteration in tissue. Analysis of these objective parameters in research and clinical field are common to determine healing rate of burn wound. Negative pressure wound therapy has been achieved wide success in treating chronic wounds. This study determines superficial burn wound healing with intermittent negative pressure wound therapy under limited access and conventional dressings. METHODS: A total 50 patients were randomised into two equal groups: limited access and conventional dressing groups. Selective biochemical parameters such as hydroxyproline, hexosamine, total protein, and antioxidants, malondialdhyde (MDA), wound surface pH, matrix metalloproteinase-2 (MMP-2), and nitric oxide (NO) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing under intermittent negative pressure. RESULTS: Patients treated with limited access have shown significant increase in the mean hydroxyproline, hexosamine, total protein, reduced glutathione (GSH), glutathione peroxidase (GPx), and decrease in MDA, MMP-2, wound surface pH, and NO. Histopathologic study showed that there was a significant difference after 10 days of treatment between limited access vs conventional dressing group, Median (Q1, Q3)=3 (2, 4.25) vs 2 (1.75, 4). CONCLUSION: Limited access was shown to exert its beneficial effects on wound healing by increasing ground substance, antioxidants and reducing MMP-2 activity, MDA, NO and providing optimal pH, decreasing necrotic tissue, amount of inflammatory infiltrate, increasing ECM deposition and angiogenesis.

Effects of limited access dressing in chronic wounds: A biochemical and histological study.

BACKGROUND: Negative pressure wound therapy has emerged as an attractive treatment modality for the management and healing of chronic ulcers. Though numerous clinical studies are available, there is a lack of biochemical and histological studies evaluating the healing of chronic wounds. MATERIALS AND METHODS: In the present study, a total 60 patients were divided into two groups: Limited access dressing (LAD) group (n = 30) and conventional dressing group (n = 30). Various biochemical parameters such as hydroxyproline, total protein and antioxidants such as reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT) and oxidative biomarker malondialdhyde (MDA) are measured in the granulation tissue. Histologically amount of inflammatory infiltrate, angiogenesis, and collagen deposition are studied to assess wound healing. RESULTS: Patients treated with LAD have shown significant increase in the mean (±standard deviation) hydroxyproline (77.3 ± 30.1 vs. 32.3 ± 16.18; P = 0.026), total protein (13.89 ± 9.0 vs. 8.9 ± 4.59; P = 0.004), GSH (7.4 ± 1.91 vs. 5.1 ± 1.28; P = 0.039), GPx (122.3 ± 59.3 vs. 88.7 ± 34.11; P = 0.030), CAT (1.80 ± 1.14 vs. 0.9 ± 0.71; P = 0.002) and decrease in MDA (13.4 ± 5.5 vs. 8.6 ± 3.8; P = 0.004). Histological study showed comparatively fewer inflammatory cells, increased and well organised collagen bundles, and more angiogenesis in the LAD group when compared with that with conventional dressing after 10 days of treatment. CONCLUSION: In the present study, we have found beneficial effect of newer intermittent negative pressure therapy in combination with moist environment (LAD) on chronic wound healing by increasing collagen deposition and angiogenesis; and reducing oxidative stress and inflammatory infiltrate.

Effect of limited access dressing on hydroxyproline and enzymatic antioxidant status in nonhealing chronic ulcers.

BACKGROUND: Healing ability of nonhealing chronic ulcers can be assessed by estimating hydroxyproline, total protein and enzymatic antioxidants such as glutathione peroxidase (GPx), glutathione S-transferase (GST) in the granulation tissue. MATERIALS AND METHOD: A total of 34 patients were analysed from two groups: Limited access dressing (LAD) group (n = 17) and conventional dressing group (n = 17). RESULTS: Patients treated with LAD that exerts combination of intermittent negative pressure and moist wound-healing had shown a significant increase in the hydroxyproline (P = 0.026), total protein (P = 0.004), GPx level (P = 0.030) and GST level (P = 0.045). CONCLUSION: Patients treated with LAD indicated significantly better anabolic effect on wound-healing compared to that of patients treated with conventional dressing.