Observations on the ultrastructure of the pericranium.

The pericranial membrane is of great interest in corrective and reconstructive procedures of the craniofacial region. A close look at its ultrastructure reveals that the outer layer is made up of loose areolar tissue and fibroblasts, and the inner layer of osteoblasts. A network of vessels near the inner layer accounts for the ability of the pericranial layer to be used as a flap based on a narrow pedicle.

Categorization of craniofacial deformities based on our experience with surgical manipulation.

A wide variety of deformities are seen by the craniofacial team. To facilitate the coding and retrieval of data collected, a system has been devised in which an attempt is made to transfer different clinical problems into units which can be processed more efficiently and encoded more exactly. The different surgical manipulations used form the basis of this system. Careful forethought and understanding are prerequisite for the utilization of this system by the craniofacial team.

Primary intracerebral tumor with mixed chondrosarcoma and glioblastoma--gliosarcoma or sarcoglioma?

An unusual primary intracerebral tumor with combined features of chondrosarcoma and glioblastoma multiforme is presented. Glial elements showing a spectrum of hyperplastic and neoplastic changes were intermingled with sarcomatous areas, similar to that recently described by Lalitha and Rubinstein as "sarcoglioma." Many vessels in the gliomatous regions contained proliferating endothelial cells with marked cytologic abnormalities. Although no direct extension out of the vessel wall was conclusively identified, the possibility of sarcomatous change could not be completely excluded. We conclude that, in this case, we could not establish whether the sarcoma was primary and the glioma secondary ("sarcoglioma") or vice versa ("gliosarcoma"), nor could we rule out that the two components originated from the same ancestral pluripotential cells.

Surgical relations of the orbit and optic nerve: an anatomical study under magnification.

Whether operating on soft tissue, bony tissue, or both, as in major craniofacial procedures, patient safety is enhanced by better understanding of the anatomical details of the orbit. The myth and mystery of the optic nerve is made clear here, especially by our magnification techniques.

Implantology for correction of cranio-facial defects with an elastomer composite and bone.

The correction of cranio-facial disfigurement in the upper part of the face is the most difficult to achieve. Various materials have been utilized and are still in use. Each has advantages and disadvantages. Autogenous bone has been used with good results, except for the unacceptable irregularities of the forehead and upper orbital region. The combination graft offers the advantages of both: the bone graft will be in contact with the dura, the periorbita and the contaminated sinuses. The polyrane implant produces a smooth and contoured forehead and immediately protects the vital structures during osteoneogenesis. Twenty-six selected patients had this technique used to correct their deformity without any incidence of major complication.

Repair of major cranio-orbital defects with an elastomer-coated mesh and autogenous bone paste.

We present a method for repairing defects in the craniofacial region in which an elastomer-coated mesh is used as a template with bone paste. The method was developed by animal experimentation first, and then successfully used in the maxillofacial and mandibular regions. We have used this method to repair 16 craniofacial defects with satisfactory results, and complications have been kept to a minimum.

Microanatomy of the optic canal.

The human optic canal, an intricate anatomical structure with several normal variations, was studied in 83 individual cadaver specimens. The landmarks and dimensions of the adjacent structures were noted and correlated with surgical exposure of the area. The transorbital-ethmoidal route for extracranial decompression of the optic canal was also studied.

Cerebrospinal fluid pressure during O2 encephalography and N2O inhalation.

Cerebrospinal fluid (CSF) pressure was studied in 8 patients and 5 dogs during pneumoencephalography (PEG) or ventriculography in which either O2 or N2O was used as the contrast gas prior to and during N2O inhalation. In 7 patients, the use of O2 as the contrast gas increased CSF pressure 8.7 torr (range 4 to 12 torr) following N2O inhalation. In 1 patient, when N2O was used as the contrast gas, CSF pressure did not change after N2O inhalation. These findings were confirmed in anesthetized animals ventilated at a constant PaCO2. The authors conclude that if N2O inhalation is required during PEG, maximum patient safety can be achieved if the contrast gas is also N2O.

A new method for reconstruction of major defects in the cranial vault.

A new method for reconstruction of cranial vault defects is described. A combination graft made of both alloplastic and autogenous materials combines several advantages to produce adequate strength and a smooth contour.