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At least 37 records · Page 2Linked to original sources
PubMed2006

Soft-helmet skull remodeling in canine models: intracranial volume unchanged by compensatory skull growth.

OBJECT: Habitual sleeping positions in infants can produce occipital plagiocephaly, which causes strabismus as well as skull and facial asymmetry. This condition can be managed using a hard helmet, but maintaining an infant in such a device is often intolerable. The authors studied whether the shape of a young canine skull could reform while inside a soft helmet and whether intracranial volume would be preserved by the compensatory growth of the skull. METHODS: The authors tracked the head sizes of 14 1-week-old beagles who wore long, soft helmets (study group) and seven beagles who did not (control group). From these measurements, the intracranial volume in each beagle was calculated. All crania were also studied radiologically by using plain skull radiography, computerized tomography (CT), and magnetic resonance (MR) imaging. The crania of all 14 beagles who wore soft helmets quickly adapted, resulting in a narrow, long head only 2 weeks into the experiment. This configuration continued to develop throughout the 7-week experimental period. At 8 weeks of age, animals in the study group showed no significantly different alteration in calculated intracranial volumes (p > 0.05). It is interesting that the helmet-treated animals initially underwent a paradoxical increase in intracranial volume growth. No structural difference in their brains was evident from CT or MR imaging findings, nor was there any functional disability. CONCLUSIONS: Intracranial volume can be preserved by the compensatory growth of the skull during successful remodeling of the developing skull achieved using a soft helmet.

Animals↗
PubMed1998

Cranioplasty with split lateral skull plate segments for reconstruction of skull defects.

This paper reports the use of cranioplasty using segments of split lateral skull plate to correct large skull defects (larger than 8 x 8 cm). The subjects consisted of 10 patients with head trauma who had undergone decompression surgery, and two patients who had undergone tumour resection. Bone grafts were obtained by cutting approximately 2 cm wide strips from the lateral skull plate using a bone saw that was inserted from a free margin of the bone defects. By cutting strips laterally from the bone defect, the necessary amount of split lateral skull plate can be obtained without performing craniotomy. The pieces of split lateral skull plate are then fixed to the defect using wire or titanium mini-plates. At this point, the selection of bone grafts that match the curvature of the dura mater is important, so that no dead spaces are created between the dura mater and the bone grafts. Infection was not detected in any of the 12 patients, and all bone grafts took completely. One of the 12 patients suffered from a pathological fracture and bone resorption 6 months after surgery. The fracture occurred because the use of basket-shaped reconstruction plates resulted in large spaces between the plate segments, and in addition the intracranial pressure was kept low by a V-P shunt, thus rendering the patient more vulnerable to atmospheric pressure.

Adolescent↗
PubMedDate not supplied

Skull base surgery for benign skull base tumors.

The use of skull base techniques in the treatment of benign skull base tumors has allowed access to areas of the brain once considered inaccessible. The most common benign skull base tumors encountered in neurosurgical practice are benign meningiomas, schwannomas, and glomus jugulare tumors. Gross total resection of these lesions gives patients the best possible chance of a cure. In this paper, we review the rationale for the use of skull base surgery techniques for benign skull base tumors.

Humans↗
PubMed2002

[Surgical approaches to the skull and near skull base neoplasms].

OBJECTIVE: To seek for the best surgical approaches to the skull and near-skull base neoplasms. METHOD: 161 patients with skull or near-skull base tumors were surgically treated. The surgical approaches were craniofacial approach in 6 cases, total maxillectomy or/with orbital exenteration in 5 cases, lateral rhinotomy in 7 cases, frontorbital approach in 1 cases, maxillary swing or extended maxillary swing approach in 21 cases, mandibular swing approach in 30 cases, cervical approach in 48 cases, postaurical large C incision approach in 19 cases, transparotid approach in 8 cases, transoral approach in 6 cases, temporofrontal approach in 8 cases, subtemporal preauricular approach in 2 cases. RESULT: Of the 98 benign tumors cases, 2 recurred postoperatively. Of the 63 malignant tumors, 1 case had cerebrospinal fluid leakage and died of intracranial infection 1.5 months postoperatively. In the follow up period, the longest one survival was over 8 years, and 10 over 5 years, 19 over 3 years, 16 over 2 years, 16 over 1 year. Survival rates of 3 and 5 years were 59.18% and 38.46% respectively. CONCLUSION: According to the site, range and pathology of the skull base neoplasmas, surgical approaches were designed and selected rationally and the effects better.

Adolescent↗
PubMed2005

Positional skull deformities in children: skull deformation without synostosis.

BACKGROUND: Patients with craniosynostosis are readily diagnosed by clinical and neuroimaging findings. Surgical treatment is indicated for preventing neurological deficits and for correcting esthetically unacceptable head deformities. In recent years, we have witnessed a progressive number of neurosurgical consultations for abnormal head shapes unrelated to premature fusion of the cranial sutures, especially of positional plagiocephaly. There have been descriptions of abnormalities in the cerebrospinal fluid (CSF) spaces in children with craniosynostosis. OBJECTIVES: The aim of the present study was to investigate the role of the changes of the CSF spaces in the development of positional skull deformities in children. PATIENTS AND METHODS: The authors reviewed demographic, clinical, and neuroimaging data of 23 patients assessed for some form of nonsynostotic skull deformity (group A). The results were compared with those of a simultaneous group of nine infants diagnosed with benign extracerebral collections of fluid (group B). RESULTS: The study group was composed of 11 boys and 12 girls, aged 3 years or younger. Seventeen children had plagiocephaly, four scaphocephaly, and two brachycephaly. Sixteen children (15 with plagiocephaly and 1 with brachycephaly) exhibited enlarged subarachnoid CSF spaces. In group B, the boy/girl ratio was of 7:2. Infants in group A presented at an older age (mean 12.7 months) than group B (mean age at presentation of 7.17 months). Children with benign extracerebral fluid collections were born with a head circumference (HC) greater than infants with positional skull deformities (p=0.005). The percentile of the children's HC at consultation was also larger for children of group B (p=0.03). The form of clinical presentation differed between the two groups. Most infants of group A were seen because of a type of head deformity, and children in group B were studied for macrocephaly. Long-term follow-up assessment showed better outcomes for patients in group B than for children of group A in regard to regression of initial symptoms (p=0.03). CONCLUSIONS: Most positional head deformities appear to be related with the children's positioning for sleeping. We have not confirmed macrocephaly as a contributing factor for positional deformities. The distribution of extracerebral CSF and the presence of abnormal collections of fluid in children with positional head deformities do not seem to be related with the findings of pericerebral CSF encountered in children with benign extracerebral collections of fluid. In our view, brain pulsations, transmitted to these accumulations of CSF, play an important part in the development of the infants' skull deformities (p=0.02). The findings of enlarged CSF spaces in children with nonsynostotic skull deformation constituted an age-related event, as these collections tended to disappear as the children grew older (p=0.04).

Cerebral Ventricles↗
PubMed1979

[The effect of changes in the bones of the skull due to Mediterranean anaemia on the shape of the skull and the formation of the cranial cavity (author's transl)].

The head and skull in patients with Mediterraneen anaemia show often a marked change of the external shape due mainly to the considerable enlargement of the cranial bones. From the abnormal external appearance the suspicion may arise that the form and space of the internal cranial cavity are likewise affected and even the basic structure of the skull is altered. However, a detailed investigation of the principal angles, distances and characteristic structures of the skull made on lateral roentgenograms of these patients, a comparison of the results between cases with different intensity of the osseous changes and a confrontation with the findings in normal individuals proved that there were no major discrepancies. The essential features of the human skull were always preserved. Only in some cases with severe alterations of the cranial bones a few small deviations from the normal values could be noticed and in a little number of them signs of a slight narrowing of the cranial cavity werde to be observed. This way was probably caused by a very early, rapid and extreme enlargement of the cranial bones resulting in a kind of "premature panzer-skull."

Adolescent↗
PubMed1985

Emergency skull radiography: the effect of restrictive criteria on skull radiography and CT use.

A prospective study was performed to determine the effect of restrictive criteria on the use of emergency skull radiography and computed tomography (CT) of the head. Emergency skull radiography required the completion of a special requisition form. Emergency CT of the head was done at the request of senior consultants and was available on a full-time basis. Over 1 year, 2,758 skull studies were performed, a decrease of 39.1% when compared with the year before restrictive criteria were instituted, during which 4,587 skull examinations were done. In the same period, the number of emergency CT scans of the head increased by 45.7%, from 471 in the control year to 686 in the experimental year. With the use of restrictive criteria, a net savings of +164,000 was achieved. Our results suggest that the use of restrictive criteria is a cost-effective means of limiting skull radiography when CT of the head is readily available.

Adolescent↗
PubMed1978

[Stereotaxic: measurements of the skull cap and skull base in merino sheep (Ovis aries L.)].

On the 14 skulls of 6-month old merino labms, stereotaxical measurements were carried out. Not only individual variations were found, but they also dependent on sex. A small assymetry was found on the diagrams of frontal measurements of the skull cap and base. The point bregma is more variable than the lambda. The position of the cranial third of the skull base in 6 month old lambs is not yet constant and until adult age it will shift about 30 degrees to 35 degrees dorsalward and forward. Since the skull cap and base do not grow parallely, and their cranial part has not constant position, we do not recommended this age group for chronic experiments with implanted electrodes. Owing to smaller variations of the skull cap and base and nearer position of the sutura sagittalis toward the medial line, male lambs would be more suitable for short-term experiments and for the stereotactic atlas of deep brain structures.

Age Factors↗
PubMed1989

[Value of skull identification as evidence using a superimposed video image technic with reference to individual craniometric differences in the human skull].

The possibility of using the video superimposition technique for the identification of a skull by comparing it with photographs of missing persons is based on the fact that the human skull, unlike any other part of the human skeleton, shows unmistakable individual characteristics. In order to obtain a quantification, the individuality of human skulls is defined in terms of craniometric data and their probability distribution. First calculations based on the coordinates of some important encephalometric points of 52 European skulls suggest that there are individual aspects comparable to those of fingerprints. Under certain conditions, the video superimposition technique can establish very strong evidence for the identity of an unknown skull, provided that it is applied correctly and carefully.

Cephalometry↗
PubMed2006

[Modified transcranial approach to resect tumor around the anterior skull base and double tissue flap to reconstruct the anterior skull base].

OBJECTIVE: To explore better approach of resecting tumor around the anterior skull base and reconstructing the anterior skull base. METHODS: In November 2004, a 49-years-old male patient with intracranial recrudescent adenoid cystic carcinoma in the anterior cranial fossa was treated using modified transcranial approach. Neurosurgeon and rhinolaryngologist cooperated to excise the tumour completely, and to reconstruct anterior skull base using the pedicle periosteum temporal musculofascial flap (15 cm x 10 cm) and the pedicle flap of aponeurosis of occipitofron tails muscle and muscular fasciae (10 cm x 6 cm). RESULTS: After operation, the wound healed by first intention. Complication, such as infection and cerebrospinal rhinorrhea, did not occur. The patient was discharged 10 days after operation, and was followed up for 8 months, no local recurrence were investigated and no scar formed over the face. CONCLUSION: The modified transcranial approach is a relatively novel exposure that enables the skilled cranial base surgeon to safely resect many malignant lesions previously and to reconstruct the defect of anterior skull base together.

Craniotomy↗
PubMed1996

Unusual tumours of the skull and skull base: a pictorial essay.

Six unusual tumours of the skull and skull base are illustrated in this pictorial essay; for three of the tumours, both magnetic resonance imaging and computed tomography were performed preoperatively. These two imaging modalities can provide complementary information in the preoperative evaluation of unusual tumours of the skull and skull base.

Adenoma↗
PubMedDate not supplied

Impact-induced intracranial pressure caused by an accelerated motion of the head or by skull deformation; an experimental study using physical models of the head and neck, and ones of the skull.

An impact incurred by the movable head may bring about a change in intracranial pressure and this change may play an important part in the occurrence of the cerebral contusion. We have carried out the following experiments to determine whether the intracranial pressure change was attributed to an accelerated motion of the head or to a skull deformation. In the blow experiment in which the head was accelerated, a positive peak in the intracranial pressure was recorded immediately after impact at the impact site and a negative one at a site opposite the impact. In the one in which the skull could be deformed, the intracranial pressure curves at both sites contained harmonics. The modal analysis revealed an inbending in the frontal and occipital regions of the skull and an outbending in the parietal and temporal regions immediately after impact, followed by a reverse deformation. Regarding the intracranial pressure change, positive pressures were recorded in the frontal and occipital regions immediately after impact, followed by a negative one. This study demonstrated that the positive and negative peaks were caused by the accelerated motion of the head, and that the curve of the intracranial pressure changes contained harmonics which were caused by the deformation of the skull.

Acceleration↗
PubMed2005

Evaluation of the distortion of EEG signals caused by a hole in the skull mimicking the fontanel in the skull of human neonates.

OBJECTIVE: Interpretation of Electroencephalography (EEG) signals from newborns is in some cases difficult because the fontanels and open sutures produce inhomogeneity in skull conductivity. We experimentally determined how EEG is influenced by a hole mimicking the anterior fontanel since distortion of EEG signals is important in neurological examinations during the perinatal period. METHODS: Experiments were carried out on 10 anesthetized farm swine. The fontanel was mimicked by a hole (12 x 12 mm) in the skull. The hole was filled with 3 types of medium differing in conductivity (air, 0 S/m; sucrose-agar, 0.017 S/m; saline-agar, 1.28 S/m). Three positions of the snout were stimulated with a concentric bipolar electrode to activate cortical areas near the middle, the edge, and the outside of the hole. The somatic-evoked potential (SEP) was recorded by a 4 x 4 electrode array with a 4mm grid spacing. It was placed on the 4 quadrants of a 28 x 28 mm measurement area on a saline-soaked filter paper over the skull, which served as artificial scalp. RESULTS: The SEP over the hole was clearly stronger when the hole was filled with sucrose- or saline-agar as compared to air, although paradoxically the leakage current was stronger for the sucrose- than saline-agar. The current leaking from the hole was strongly related to position of the active tissue. It was nearly negligible for sources 6-10 mm away from the border of the hole. The distortion was different for 3 components of the SEP elicited by each stimulus, probably indicating effects of source distance relative to the hole. CONCLUSIONS: EEG is strongly distorted by the presence of a hole/fontanel with the distortion specifically dependent on both conductivity of the hole and source location. SIGNIFICANCE: The distortion of the EEG is in contrast to the lack of distortion of magnetoencephalography (MEG) signals shown by previous studies. In studying brain development with EEG, the infant's head and sources should be modeled accurately in order to relate the signals to the underlying activity. MEG may be particularly advantageous over EEG for studying brain functions in infants since it is relatively insensitive to skull defects.

Animals↗
PubMed2004

Endoscopic endonasal skull base surgery: Part 1--The midline anterior fossa skull base.

OBJECTIVE: An endonasal endoscopic surgery to the anterior fossa skull base was developed in cadaver dissection as a minimally invasive surgical technique and, subsequently, used in patient treatment. METHODS: Six cadaver head specimens were used. Ideal head positioning and various surgical routes were studied. To estimate the extent of surgical exposure provided by this technique, the width of the exposed anterior cranial fossa was measured between the medial margin of the orbits, the optic nerves and the carotid arteries. Three demonstrative patient cases are presented. RESULTS: Ideal head positioning was discovered to be at 15-degree extension of the forehead-chin line. Paraseptal, middle meatal and middle turbinectomy approaches were developed. The average width between the medial orbits was measured to be 24 mm (range 22-29 mm) at the crista galli level, 27 mm (range 24-30 mm) at the planum sphenoidale, 18 mm (range 15-22 mm) between the optic nerves, and 17 mm (range 13-21 mm) between the rostral carotid siphons. This technique, when it was applied in patient care, proved to be minimally invasive. CONCLUSIONS: This endoscopic endonasal approach provided a direct "short-cut" access to the midline anterior fossa skull base. This technique can be used for the surgical treatment of cerebrospinal fluid (CSF) leak, meningiomas, craniopharyngiomas, pituitary adenomas, and other midline intracranial anterior skull base lesions. This is the first report in the English literature describing endonasal endoscopy for the surgical treatment of primary intracranial anterior fossa skull base lesions.

Adult↗
PubMedDate not supplied

Intracranial aneurysm and hemorrhage following skull caliper traction. Review of skull traction complications.

Serious complications of caliper skull traction for fracture-dislocations of the cervical spine are so rare that they are not discussed in most standard textbooks. A fusiform intracranial aneurysm which followed the placement of skull tongs is reported. Subsequent aneurysmal rupture produced an intracerbral hematoma requiring drainage. The literature recording the complications of skull caliper traction is reviewed and the indications for skull traction and the need for scrupulous surgical technique are emphasized.

Cerebral Hemorrhage↗
PubMed2003

Imaging in tuberculosis of the skull and skull-base: case report.

We report a 19-year-old girl, who presented with headache and tonic/clonic seizures. Imaging revealed a lytic parietal skull lesion with an adjacent epidural mass, masses in the right parietal lobe and a posterior skull-base mass. The diagnosis of tuberculosis was made after resection of the extradural mass and later verified with culture of Mycobacterium tuberculosis. The parenchymal and skull-base lesions resolved following antituberculous treatment. We present CT, scintigraphic, angiographic and MRI findings.

Adult↗
PubMed1994

Intraosseous calvarial meningioma of the skull presenting as a solitary osteolytic skull lesion: case report and review of the literature.

Intraosseous calvarial meningiomas, defined as meningiomas confined to the skull with no epidural or subcutaneous component, are rare and usually exhibit osteoblastic activity. We present a case of a primary intraosseous meningioma in the right frontal bone that presented radiologically as a solitary lytic skull lesion and was completely excised. The lesion was benign without recurrence for 1 1/2 years. According to our review of the literature, our case is the first with documentation on computed tomography. In cases of solitary osteolytic skull lesions, meningioma should be considered even though it may not seem likely, because management will be directed to radical excision with good prognosis rather than biopsy.

Aged↗