[Undiagnosed skull fractures in a casualty ward. The importance of simple fractures of the skull for late sequelae].
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[The "cloudy" skull and skull-deformities in suturesynostoses as an indication for extensive calotte-resection].
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Child↗
[Consequences of an axis incongruence between skull-coordinated maxillary models and skull-coordinated mandibular models].
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Dental Articulators↗
Autogenous skull cranioplasty: fresh and preserved (frozen), with consideration of the cellular response.
Every craniotomy requires immediate replacement of a fresh autograft of skull or, in the presence of cerebral swelling, delayed reimplantation of preserved autogenous skull. Resumption of osteogenesis, the index of viability, determines the effectiveness of these segments of calvaria in protecting the brain and restoring skull conformity. The cellular response in skull replaced either at the end of craniotomy or after frozen preservation was studied by light and fluorescence microscopy, skull roentgenograms, and radionuclide scintigraphy. In 5 patients eventual total remodeling of skull was found at the time of a second craniotomy performed from 1 to 19 years after the first. In 12 patients skull sections removed aseptically at craniotomy were frozen and stored for 1 to 35 months at -20 degrees C in bacitracin. This cytotoxic preservative method fixed the tissue, which appeared unchanged on light microscopy and was sterile on bacteriological and fungal cultures. In 53 patients who underwent autogenous cranioplasty with skull stored frozen for 3 weeks to 19 months, 48 operations were totally successful. Complications included infections in 2 patients, resorption in 2 infants, and incomplete restoration in 1 adult. In 10 patients the sequential dynamics of skull revitalization were found to be: revascularization, resorption, and accretion. The repair of membranous skull is similar to that of endochondral bone of the skeleton. Skull is metabolically intensely active after reimplantation and is the ideal material for cranioplasty.
Adolescent↗
Analysis of the sexual dimorphism in the basioccipital portion of the dog's skull.
Sexual differences in the basioccipital portion of the skull of dogs have been described and an index is presented which reliably predicts the sex of the skull. 92 dolichocephalic skull (44 male, 48 female) from mongrel dogs were used. In the basioccipital region of the male skulls, a triangular area, which extends from the basion to a line joining the medialmost points of the two jugular foramina, appears narrow and elevated. The pharyngeal tubercle is also prominent. In female skulls the rostral angle of this triangle is wider and the triangular area seems smoother and flat. The anterior half of the female basioccipital portion is wider and smoother than in the male skull. In order to quantify the observed differences, four indices were calculated. All of the indices were statistically significant. However, only index IV could be reliably used in predicting the sex of an unknown skull: (formula: see text) was derived from breadth IV (distance between the two temporo-occipital fissures at their lateralmost points) and length II (distance between the basion and a line drawn between the two medialmost points of the jugular foramina in the midline). Values of less than 123 for male and greater than 136 for female placed the skulls in their proper sex group. Skulls that had intermediate values could be placed in correct sex grouping only in conjunction with strong observational criteria. It is suggested that in absence of such strong observational criteria these skulls may belong to immature or castrate animals.
Animals↗
Acoustical properties of the human skull.
The acoustical properties insertion loss, reflection loss, and sound speed were measured on a series of fresh and subsequently formalin immersed human skulls. Measurements were made in the frequency range from 0.25 to 6 MHz. Most studies were restricted to an upper frequency limit of 2.2 MHz. An axisymmetric focused beam configuration was used as the sound source for the measurements and the receivers were small disk-type (3-mm-diam) piezoelectric ceramics. The geometric and temporal character of the focused beam was studied as a consequence of passage through the skull sections. Some skulls were sectioned so that their individual layer components could be studied. A simple three-layer analytical model seems to explain the major aspects of insertion and reflection loss. The dominant feature in determining human adult skull losses is the middle layer (diploe) of cancellous bone. This study corroborates previous work on insertion loss as a function of frequency for composite skull. The study provides new quantitative information on the acoustic scattering properties of diploe, sound velocity, and dispersion in composite skull and its components, attenuation coefficients in skull components and sound-beam distortion and shifts after transmission through composite skull. We conclude that with selection of appropriate frequencies (0.5-1.0 MHz) and beam configuration it will be possible to perform clinically significant transkull diagnostic imaging and interrogation in the adult human brain.
Acoustics↗
[Asymmetry in artificially deformed skulls from a Protobulgarian mass grave of the 9th century].
A series of 18 skulls with pronounced asymmetry, picked up out of a total of 52 artificially deformed and accordingly restored skulls are studied. It is a matter of material discovered in a circular tomb near by the village of Devnja, dating back to the end of the 9th century. To obtain metrical determination of the asymmetry, the authors performed measurements of chords, resp. arches between the anthropological points sphenion and asterion, as well as of the distance from the latter and from the porion on either side up to the glabella, inion, bregma and lambda. Besides the 18 sizes directly recorded, 18 chords constructed on the craniograms (three per skull) mainly between the above mentioned points were also utilized. For each dimension the absolute differences between left and right, the mean value of the differences and the asymmetry index after Duncker were calculated. Using the method outlined, an accurate and quantitative determination was made of the asymmetry both in the occipito-parietal and temporo-clinoidal parts of the skull (compensatory and persisting asymmetry). It is demonstrated that the discrepancies between some of the size values established in individual skulls, and the skull asymmetry, recorded scopically with other measurements, are due to displacements of the anthropological points (sphenion, asterion, inion), produced by differences in growth rate and size of bones. The arrested development of bones and the resulting depressions along their surfaces under the effect of the artificial deformation dressing are of utmost importance for the processes developing within the deformed skulls.
Anthropology, Cultural↗
[Notes on Indian skulls from Venezuela and the Dominican Republic].
Ten Indian skulls from Venezuela and the Dominican Republic, respectively, have been examined anthropologically. Three of these skulls are from adolescent individuals, the remaining seven from adult ones. Four skulls were artificially deformed (tabular obliqua type). Out of the seven adult skulls five are male, two probably female. The measurements and indices are mostly within the variation range of hitherto already known values from these regions. Considering all factors one can see a population having relatively short, median wide and in general low skulls, which are also characterized by low to median cranial capacities. The face is dominated by high orbitae. The cheek bones are median wide, compared to other South American groups. The nose is often short. Its width is differing whereas, however, narrow to median wide nasal openings are prevailing. For the present it is not possible to differentiate this skull material either regionally or chronologically.
Adult↗
A second look at the utility of radiographic skull examination for trauma.
A prospective study tested the hypothesis of Bell and Loop (1971) that 21 high yield findings are significantly associated with the presence of a skull fracture and can be used to decide which patients need skull radiography. In our study, 17 fractures were detected in 594 patients who had skull radiography because of trauma to the head. Six of these fractures occurred in children who had none of the 21 Bell and Loop high yield findings. These six patients were asymptomatic except for superficial injury at the site of trauma. Had the Bell and Loop criteria been used to decide which patients had skull radiography, 35% (all in children) of the fractures would have gone undetected. Thus, in our study population, the Bell and Loop high yield findings were not satisfactory criteria for the decision about obtaining skull films in children.
Adolescent↗
[Experimental studies on the development of human skull fractures].
Pressure tests were performed on certain well-defined points in the median-sagittal plane of soft part covered skulls of 40 human corpses. It was found that the elastic behaviour of the skull obeys Hooke's law, thus the modulus of elasticity is the Ist differential quotient in the stress-strain diagram. Beside the vectorial nature of the compression force the point of application is also of decisive importance. The globe-ellipsoid theories do not correspond to the structure of human skulls. Autopsy revealed over 50% more confirmed fractures than the X-ray pictures. This contradiction in the diagnosis of fractures on the human skull can be reduced by series of X-ray pictures. The lines of the fractures run to the most part along the Benninghoff--Goerttler pillars of strength. Additional biostatic parameters (maximum load before breaking, coefficient of elasticity, stress, elongation etc.) were also obtained which permit an insight into the specific mechanic structure of the human skull and its load-bearing ability.
Biomechanical Phenomena↗
[Multi-projection skull x-rays].
An X-ray method of examination of the skull bones is discussed which is used for detecting multiple small perforating defects in the skull of various localization, determination of the localization of foreign bodies in relation to definite anatomical structures, identification of the displacement of the bone fragments into the cranial cavity, and for the diagnosis of multiple infractions of the cerebral skull. Besides two antero-posterior craniograms, radiograms were taken in additional oblique views with the head turned to the right or to the left in the interval of 20 to 45 degrees. The guiding points for the direction of the X-ray heam are: the lateral border of the superciliary arch, the midpoint between the lateral border of the superciciliary arch and the external acoustic meatus, the midpoint between the external acoustic meatus and the external occipital protuberance. The effectiveness of the method was tested on a skull phantom and verified by observations over 3 patients with multiple infractions of the skull bones.
Adult↗
Lacunar skull deformity related to intelligence in children with myelomeningocele and hydrocephalus.
It has been suggested that the presence of lacunar skull deformity in infants with myelomeningocele and hydrocephalus is indicative of later lowered intelligence and therefore is a useful criterion in early selection for treatment. In the present study, retrospective investigations were made of the clinical records and skull X-rays of 169 surviving children who had been admitted immediately after birth with myelomeningocele and hydrocephalus to the Children's Hospital, Sheffield. Adequate X-rays were available for 131 of the children, of whom 97 per cent exhibited some degree of lacunar skull deformity. At five years of age or older, the 131 children were tested on the Wechsler Intelligence Scale for Children. The differences in mean IQ between the various degrees of severity were not large, and it was found that 82 per cent of children with the most severe degree of lacunar skull deformity had IQs above 70. These findings do not support the use of lacunar skull deformity as an important measure in selection for treatment of children with myelomeningocele and hydrocephalus.
Cerebrospinal Fluid Shunts↗
Biology of the rice rat (Oryzomys palustris natator) in a laborabory environment. X. Postweaning growth of the skull.
A survey of skull development of the rice rat (Oryzomys palustris natator) covering a period of 21 days to 16 months involving equal numbers of males and females (108) was undertaken using various skull parameters. Sexual dimorphism in relation to body weight and length emerged before that of the skull which was only clearly marked by 2 months. A number of the skull parameters by virtue of their individual growth potential did not show sexual differences in size for a long time, whereas others were clearly marked. Once the differences between the sexes had been established they were maintained. One parameter - lenght of cranium - represents those parameters which show changes and it was found that the male rat continued to show a steady linear increase in length up to 16 months, whereas the female cranial length shows a deceleration with termination around 12 months. The skull differences are mirrored in the weight and length findings and it suggested that the earlier sexual maturity of the females is compensated by an earlier cessation of growth compared to the males which mature later and have a correspondingly later cessation.
Animals↗
[Radiological anatomical examinations in skulls from anthropological collections (author's transl)].
A total of 114 skulls dating from the Neolithic Age, the Bronze Age and the Iron Age, of Incas and Red Indians, of Asians from North and South China, as well as Negro skulls found in Turkey were radiologically analysed and compared with control skulls of recent origin. The 3 standard X-ray views were taken (postero-anterior, axial and lateral) and appropriate linear and angle measurements were carried out. The resultant 4120 values were compared by variance analysis and the differences between the groups are presented. The differences in linear values may be attributable merely to racial variation; the constancy of the obtained angle measurements is striking. The results were also compared by means of linear regression with measured volume values of the brain skull; it was thereby possible to develop a new formula by means of which the volume of the brain skull can be calculated from the parameter BPH (introduced by the author) and from the distance B with the help of a constant factor. The importance of Radiology in Anthropology is pointed out.
Anthropology, Physical↗
[Post-natal growth of the skull in the house mouse Mus musculus Linné, 1758, and in 2 different large subspecies of the field mouse Microtus arvalis Pallas, 1779. II. Results (I)].
Postnatal skull ontogeny of Mus musculus, Microtus arvalis arvalis and M. a. asturianus was studied qualitatively and quantitatively. To facilitate age determination for undated specimens, the most important stages in ossification of the skull bones are described, with drawings of selected ontogenetic stages (Part I). Using Parameter C of the growth function Y(t) = A - B exp (- Ct), it is possible to establish skull growth gradients. The growth functions are subdivided into 3 classes, based on Parameter C, associated with different growth regions of the skull. Changes in individual skull proportions are demonstrated by means of ontogenetic and intraspecific allometries.
Animals↗
Growing skull fracture of childhood with reference to the importance of the brain injury and its pathogenetic consideration.
It is recognized that the presence of a dural tear is essential in the development of a growing skull fracture. We present nine cases of growing skull fracture, stressing the importance of parenchymal injury beneath the skull and dural defects as pathogenic factors, and two cases which showed pathological conditions similar to those of growing skull fracture. According to our clinicla analysis, all of these cases followed head trauma in the first year of life. The area of cranial defect varied in size among the individual cases but was progressive in all instances. Convulsions were the most frequent symptom. With both radiologicla examinations and operative findings, it is recognized that dural tears and local cerebral injury are usually severe, and various localized ventricular enlargements are always found beneath the fracture. In many cases fibrous granulation was found filling in the bone defect and adhering to the contused cortex. The mechanism of the enlarged bone defect can be explained by classifying the lesions into three groups according to the type of tissue present: (1) granulation type; (2) cyst type, and (3) mixed type. Each type prevents the bone edge from spreading out, offering a suitable means to transmit mechanical pulsations of brain and cerebrospinla fluid. The formation of granulation tissue and dense scarring is an important factor in the growing skull fracture.
Brain Diseases↗
A clinical-radiographic classification of skull base lesions.
Lesions involving the base of the skull can be divided into primary and secondary disease processes. The primary group consists of bone lesions more often seen elsewhere in the skeletal system while the secondary group consist of those lesions extending to the base of the skull by direct extension from adjacent intracranial or extracranial sites. The purpose of this paper will be to arrive at a classification of skull base lesions based on the roentgen localization of the disease process. The base of the skull because of its anatomically variable curvature can be difficult to evaluate on good quality conventional radiographs. In addition to the changing angles of the bone itself, the overlying soft tissues of the pharynx and neck only serve to further conceal areas of bone pathology. The advent of polytomography and CAT scanning has greatly aided the evaluation of this region which clinically is extremely difficult to assess. In some instances invasive modalities such as angiography and posterior fossa myelography are necessary to define the lesion. With these diagnostic methods available, rather than discovering classical patterns of disease, a variety of disease processes have been found that radiographically mimic each other. Similarly, on a purely clinical basis, many of the disease entities present in a similar fashion. It is only by a combined approach that an intelligent differential diagnosis can be offered.
Adolescent↗
Traumatic intracerebral haematoma: complication of skull caliper traction. Case report.
Recently, a unique case of traumatic intracerebral haematoma complicating the insertion of skull calipers, has been observed. It is assumed it was due to: 1. the accidental penetration of the burr into the skull, while making the insertion hole for the caliper; 1. the failure to grip the skull with the special metal sleeve, the Blackburn skull caliper is provided with, so that the end plates were free to move in and out of the skull in this restless patient. The correct diagnosis was made only after severe uncal herniation had developed. The reasons for missing the correct diagnosis within useful time for proper treatment are considered to be: 1. carotid angiography performed too early in the process of haematoma formation: 2. the vascular displacements were only slight and not fully diagnostic; 3. a recognized complication, extradural haematoma, had already been excluded.
Cerebral Angiography↗