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PubMed1999

Vibroacoustic and scalp stimulation.

Both VAS and scalp stimulation are useful in the evaluation of fetal compromise by decreasing the number of falsely abnormal FHR tests and limiting the number of unnecessary interventions, thus improving the efficiency of antepartum and intrapartum FHR monitoring. As is true for all types of fetal assessment using FHR monitoring, VAS and scalp stimulation have limitations, and a lack of response to these methodologies does not necessarily indicate fetal acidemia. When either VAS or scalp stimulation is employed, one must take into consideration their respective predictive values (see Table 1). Fetal VAS or scalp stimulation should be considered as one facet of comprehensive fetal evaluation. When these techniques are used in this manner, the clinician evaluating the fetus in the antepartum or intrapartum period may prevent unnecessary intervention and improve maternal and neonatal outcome.

Acoustic Stimulation↗

PubMed1995

Intra-operative scalp expansion for wound closure without tension in craniosynostosis operation--technical innovation.

Primary scalp wound closure using intra-operative scalp expansion in a craniosynostosis operation is described. Since this method enables easy scalp expansion, it is considered to be a useful adjunctive technique which should be taken into account when closing scalp wounds in craniosynostosis surgery, where the risk exists of cranial expansion-induced compression and deformity of the remodelled bone flaps after bone fixation.

Craniosynostoses↗

PubMed1991

Experiences in surgical repair of a totally avulsed scalp.

A case of total scalp avulsion is described in surgical detail. The neurovascular bundles remained nearly untouched on the surface of the galea aponeurotica. Only one frontal branch of the left temporal artery was found to serve as a nutrient vessel for the whole scalp. Three veins around the scalp circumference supplied the venous drainage. The right-dorsal part of the scalp underwent necrosis, obviously because of internal disruption on the capillary level. This area had to be skin-grafted secondarily. Mechanical aspects in respect of the neuro-vascular situation are discussed theoretically and some advice on the surgical approach is derived from our experience.

Adolescent↗

PubMed2000

Scalp EEG in temporal lobe epilepsy surgery.

Electroencephalography (EEG) with standard scalp and additional noninvasive electrodes plays a major role in the selection of patients for temporal lobe epilepsy surgery. Recent studies have provided data supporting the value of interictal and postictal EEG in assessing the site of ictal onset. Scalp ictal rhythms are morphologically complex but at least one pattern (a five cycles/second rhythm maximum at the sphenoidal or anterior temporal electrode) occurs in >50% of patients and has a high predictive value and interobserver reliability for temporal lobe originating seizures. Thorough interictal and ictal scalp EEG evaluation, in conjunction with modern neuroimaging, is sufficient for proceeding to surgery without invasive recordings in some patients. Further studies are required to define the scalp ictal characteristics of mesial vs. lateral temporal lobe epilepsy.

Electroencephalography↗

PubMed2005

Intracranial invasion of a basal cell carcinoma of the scalp.

OBJECTIVE AND IMPORTANCE: Basal cell carcinomas are common lesions that can have a locally invasive behavior. The authors present a case of a scalp lesion with skull and dura-mater invasion that was unrecognized prior to surgical undertaking. CLINICAL PRESENTATION: A 66-year-old female presented with an extensive ulcerating lesion on the frontal scalp, deemed to be a basal cell carcinoma. The plastic surgery team brought her to the operating room for resection but subsequently backed off after the discovery of bony invasion. Imaging revealed extensive bony and epidural extension. INTERVENTION: Resection of the invaded frontal scalp, bone, dura-mater and proximal part of the superior sagittal sinus was performed. This was followed by a reconstructive procedure consisting of a duraplasty, a cranioplasty, and a skin rotation flap and partial-thickness skin grafting. CONCLUSION: Radiological evaluation of scalp basal cell carcinomas should be done prior to surgery to rule out any bony or intracranial invasion.

Aged↗

PubMed2001

Co-registration of EEG and MRI data using matching of spline interpolated and MRI-segmented reconstructions of the scalp surface.

Accurate co-registration of MRI and EEG data is indispensable for the correct interpretation of EEG maps or source localizations in relation to brain anatomy derived from MRI. In this study, a method for the co-registration of EEG and MRI data is presented. The method consists of an iterative matching of EEG-electrode based reconstructions of the scalp surface to scalp-segmented MRIs. EEG-electrode based surface reconstruction is achieved via spline interpolation of individually digitized 3D-electrode coordinates. In contrast to other approaches, neither fiducial determination nor any additional provisions (such as bite bars, other co-registration devices or head shape digitization) are required, and co-registration errors associated with inaccurate fiducial determination are avoided. The accuracy of the method was estimated by calculating the root-mean-square (RMS) deviation of spline interpolated and MRI-segmented surface reconstructions in 20 subjects. In addition, the distance between co-registered and genuine electrode coordinates was assessed via a simulation study, in which surface reconstruction was based on virtual electrodes determined on the scalp surface of a high-resolution MRI data set. The mean RMS deviation of surface reconstructions was 2.43 mm, and the maximal distance between any two matched surface points was 5.06 mm. The simulated co-registration revealed a mean deviation of genuine and co-registered electrode coordinates of 0.61 mm. It is concluded that surface matching using spline interpolated reconstructions of scalp surfaces is a precise and highly practicable method to co-register EEG and MRI data.

Adult↗

PubMed2002

Scalp VEPs and intra-cortical responses to chromatic and achromatic stimuli in primates.

We propose asimple method of monitoring separate visual pathways inlightly sedated monkeys using chromatic and achromatic gratings of low contrast, which are known to activate predominantly either parvo- or magno-systems. The scalp Visual Evoked Potentials (VEPs) are compared with simultaneously recorded intra-cortical VEPs which in turn are compared with multi-unit and single-unit responses. At isoluminance, the onset of low contrast, coarse chromatic square wave spatial profile gratings generates negative scalp VEPs which exhibit properties consistent with the activation of sustained, parvocellular-chromatic mechanisms (e.g. low-pass spatio-temporal characteristics). In monkeys, most components of chromatic onset VEPs have latencies comparable to neuronal activity within the supragranular layers of V1. Corresponding coarse achromatic gratings elicit positive VEPs which exhibit properties consistent with the activation of transient-type magnocellular mechanisms (e.g. temporal tuning to higher temporal frequencies) and which have a more complex morphology. Achromatic onset VEPs may contain early components of similar timing to activity recorded in monkey V1, but later components cannot be related to V1 generators; other sources are not known. Achromatic reversal VEPs are similar to achromatic onset, chromatic reversal and both chromatic and achromatic offset VEPs and all differ from chromatic onset VEPs. It is observed that early components of scalp-recorded chromatic-onset VEPs are related in time to some intra-cortical potentials. These VEPs are generated by low spatial frequencies and have low pass temporal characteristics. Other scalp potentials, apparently unrelated to V1 field potential activity must be generated by other sources such as extra-striate areas.

Animals↗

PubMed1998

Scalp-recorded EEG localization in MRI volume data.

Scalp-recorded EEG is a noninvasive and widely available tool for studying normal and dysfunctional human neurophysiology with unsurpassed temporal resolution. However, scalp-recorded EEG data is difficult to correlate with anatomy, and most current display and neural source estimation algorithms are based on unrealistic spherical or elliptical models of the head. It is possible to measure the positions of electrodes on the patient's scalp, and to register those electrode positions into the space of a high-resolution MRI volume, and to then use the patient-specific anatomy as the basis for display and estimation of neural sources. We use a surface matching algorithm to register digitized electrode and scalp surface coordinates to a three-dimensional MRI volume. This study uses fiducial markers in phantom and volunteer studies to quantitatively estimate the accuracy of the electrode registration method. Our electrode registration procedure is accurate to 2.21 mm for a realistic head phantom and accurate to 4.16 mm on average for five volunteers. This level of accuracy is considered within acceptable limits for clinical applications.

Algorithms↗

PubMed2000

Estimating scalp MEG from whole-head MEG measurements.

Studies based on whole-head MEG recordings are providing more and more impressive results. In such recordings, the MEG sensors are several centimeters away from the scalp and the positions of the MEG sensors with respect to the head differ from subject to subject, and from session to session for the same subject. In this paper, a method is presented and tested to estimate the scalp MEG distributions from whole-head MEG measurements. The goal is to remove the discrepancy of MEG measurements caused by the various sensor positions with respect to the head, as well as to reduce the smearing effect caused by the distance of the MEG sensors from the scalp. The MEG measurement was first projected to a hypothetical dipole layer within the head volume conductor model using the inverse solution. The scalp MEG estimation was then obtained from the resultant dipole layer by the forward solution. The results from simulation studies, phantom experiments, and the auditory evoked field analysis demonstrated that, with reasonable signal to noise ratios, this method is a feasible way to achieve our goals.

Auditory Cortex↗

PubMed2003

Validation and clinical relevance of a novel scalp coverage scoring method.

BACKGROUND/AIMS: Distinctive patterns of defective scalp skin coverage or alopecia have been identified by clinicians but do not help measuring the dynamics of hair changes over time. Hence, we conceived the scalp coverage scoring (SCS) method that integrates cumulative changes of hair growth or loss. In this paper, we report the results of validation studies demonstrating that the SCS can be applied in real time in the clinic or on global photographs for evaluating the severity of androgenetic alopecia (AGA) of male subjects and for monitoring changes over time. METHODS: Different panels totalling 38 different male subjects with AGA were classified according to a modified Norwood-Hamilton scale and were evaluated with the SCS system (real time or global photographs). The contrast-enhanced phototrichogram method (CE-PTG), a refined non-invasive and validated analytical technique was used for calibration purposes. RESULTS: The real time SCS was correlated with SCS on global photographs. The inter- and intra-observer variation of SCS obtained on global photographs was less than 3%. The real time SCS was negatively correlated with the clinical staging of male pattern baldness according to the modified Norwood-Hamilton scale, confirming less scalp coverage in more severly affected subjects. In 12 male subjects with AGA, after SCS evaluation of the top of the head, a 1-cm2 central target site was explored with CE-PTG. There was a significant correlation of real time SCS with the percentage of thick anagen hair (r = 0.53; P < 0.08) and with the density of thin hair (r = -0.68; P < 0.02). Changes over time as documented on global photographs (18 subjects at baseline and after 12 and 60 months) were rated by a panel of independent experts (paired photographs) who were not blinded as to time. Randomised individual photographs were also examined one at a time for SCS. This procedure documents data obtained without control of baseline photographs and establishes blinding as to time. The changes calculated from SCS (after-baseline) were correlated (r = 0.9; P < 0.0001) with the rating of the panel of experts. CONCLUSIONS: When minimum technical precautions are taken prior to the scoring session, the main points of interest of the SCS method are: Non-invasive quantitative and reproducible technique. Measures dynamics of scalp hair growth and loss. Easily applied in the hair clinic.

Alopecia↗

PubMed1982

Prekeratin biosynthesis in human scalp epidermis.

Analysis of human scalp epidermal prekeratin polypeptides by two-dimensional gel electrophoresis revealed that each of the bands observed in one-dimensional electrophoresis consisted of three to five polypeptides of the same molecular weight but differing in isoelectric points. It was possible to divide the polypeptides into two families, with isoelectric points in the ranges pH 6.0-8.0 and pH 5.0-5.5 respectively. Incorporation of radiolabelled amino acids into freshly excised pieces of scalp epidermis showed that some of the polypeptides had relatively greater contents of glycine and serine than others. Radiolabelled methionine and leucine were, in contrast, incorporated more or less uniformly into all the polypeptides. After incubation with 32P-labelled orthophosphate, relatively more intense labelling by 32P was observed in the higher molecular weight bands of each family. The most basic of the isoelectric variants in each case did not take up phosphate, implying that at least some of the variation in charge was due to different degrees of phosphorylation. Polyadenylated RNA isolated from scalp epidermis was translated in an RNA-dependent reticulocyte haemolysate system followed by immunoprecipitation and electrophoresis. The polypeptides isolated by using anti-(human scalp prekeratin) immunoglobulin G had similar electrophoretic mobilities in sodium dodecyl sulphate/polyacrylamide gels to authentic prekeratin polypeptides, but had different isoelectric properties. This suggested that the products of keratin gene expression undergo post-translational modification.

Amino Acids↗

PubMed2003

Computerized morphometry and three-dimensional image reconstruction in the evaluation of scalp biopsy from patients with non-cicatricial alopecias.

BACKGROUND: A major challenge in the histopathological examination of scalp biopsies is to perform an adequate evaluation of all the hair follicles present in the tissue. Transverse sectioning is currently the preferred technique to demonstrate every follicular structure in a punch biopsy specimen, although diagnostic accuracy is dependent on subjective evaluation of follicular morphology and hair size. OBJECTIVES: To determine if computer-based morphometry and three-dimensional (3D) image reconstruction software can be used to evaluate scalp biopsies from patients with non-cicatricial alopecias. METHODS: Nine 4-mm scalp punches were taken from nine patients with noncicatricial alopecias and step-sectioned transversely at 0.1-mm intervals from the epidermal surface to the subcutaneous fat. Each tissue section was then digitized and analysed using morphometric and 3D image reconstruction software. Morphometric data and 3D images were collated with clinical and conventional light microscopic diagnoses, as well as follow-up information. RESULTS: In four of the nine patients, results of morphometric analysis concurred with conventional clinicopathological diagnoses. In the remaining five patients, morphometry revealed a lower telogen count in one patient and higher telogen count in four patients. One of the four patients with a higher telogen count also had a low mean hair diameter and miniaturized anagen follicles in the 3D image that were suggestive of early androgenetic alopecia (AGA). 3D virtual microscopic imagery allowed the direct visualization of colour-coded, scaled hair follicles which demonstrated characteristic changes in alopecia areata, AGA and telogen effluvium. CONCLUSIONS: Our study demonstrated the feasibility of using morphometric and 3D reconstruction software to evaluate scalp biopsies. With further validation, this technique may prove to be more sensitive to detect subtle quantitative and qualitative follicular changes in non-cicatricial alopecias.

Adolescent↗

PubMed2002

Management of large surgical defects of the forehead and scalp by imbrication of deep tissues.

BACKGROUND: When facing surgical defects, the dermatologic surgeon follows certain basic principles that help reduce the inherent tension to allow for a better cosmetic outcome. These commonly include the use of undermining, releasing technique such as galeotomy if applicable, selection of suture material of appropriate tensile strength, and closure along relaxed skin tension lines. OBJECTIVE: To review the imbrication of deep tissues, another surgical principle aimed at wound tension reduction and widely utilized by cosmetic surgeons in forehead lifts and scalp reductions, as it applies to dermatologic surgeons in the repair of large surgical defects of the upper face and scalp. The latter may be utilized both with primary closure and with local flaps. METHODS: We describe in detail the technique of imbrication of deep tissues and provide illustrations for a better understanding of how to correctly use this surgical principle. RESULTS: The dermatologic surgeon has an additional tool, termed imbrication of deep tissues, available to aid in the closure of sizable wounds of the forehead and scalp as seen following Mohs surgery for cutaneous malignancies by providing deep tissue support. CONCLUSION: Imbrication of deep tissue is an effective tool that may be used by dermatologic surgeons in conjunction with the more commonly utilized basic surgical principles to enhance the cosmetic outcome in the closure of large, high-tension defects of the forehead and scalp.

Forehead↗

PubMed2003

Giant fibrosarcoma arising in dermatofibrosarcoma protuberans on the scalp during pregnancy.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence; however, it seldom metastasizes. Most lesions occur over the trunk or proximal extremities, and there is slight male preponderance. DFSP is rare on the head and neck. Less than 5% tumors are located on the scalp. OBJECTIVE: To describe a case of giant fibrosarcoma arising in DFSP on the scalp during pregnancy. METHOD: In our patient, the tumor was on scalp and measured 15 x 11 x 7 cm. The recurrent tumor that developed in the same region was measured 33 x 30 x 15 cm. Histopathologic examination of this mass revealed fibrosarcoma. The mass was excised from the subperiosteal plane with a 3-cm free margin. Because of the high possibility of recurrence, the defect site was reconstructed with a split-thickness skin graft. RESULTS: After 1 year of follow-up, no recurrence or metastasis was detected. CONCLUSION: We present a unique case in which the person has a giant fibrosarcoma on her scalp arising from DFSP with fibrosarcomatous change during pregnancy.

Adult↗

PubMedDate not supplied

Scalp metastasis from squamous cell carcinoma of the cervix.

We describe a 45-year-old woman with squamous cell carcinoma of the cervix stage IIB, who was initially treated with radical radiotherapy. The patient developed multiple scalp metastases 8 months following her treatment. The scalp was involved in the disease as the sole anatomic site of distant cutaneous metastasis. The scalp lesions were treated with palliative radiotherapy. A search of the literature revealed only two cases of such distant metastatic involvement of the scalp from cervical cancer.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Hereditary hypotrichosis simplex of the scalp.

Hereditary hypotrichosis simplex of the scalp is a genotrichosis characterized by sparse or absent scalp hair without structural defects, in the absence of other ectodermal or systemic abnormalities. We describe two Spanish families with hypotrichosis of the scalp. We believe these families have Toribio and Quiñones type hereditary hypotrichosis simplex of the scalp.

Adult↗

PubMed2002

Focal ictal beta discharge on scalp EEG predicts excellent outcome of frontal lobe epilepsy surgery.

PURPOSE: To determine whether a focal beta-frequency discharge at seizure onset on scalp EEG predicts outcome of frontal lobe epilepsy (FLE) surgery. METHODS: We identified 54 consecutive patients with intractable FLE who underwent epilepsy surgery between December 1987 and December 1996. A blind review of EEGs and magnetic resonance images (MRIs) was performed. Lesional epilepsy is defined as presence of an underlying structural abnormality on MRI. RESULTS: Overall, 28 (52%) patients were seizure free, with a mean follow-up of 46.5 months. Presence of a focal beta-frequency discharge at seizure onset on scalp EEG predicted seizure-free outcome in lesional (p = 0.02) and non-lesional (p = 0.01) epilepsy patients. At least 90% of patients who had either lesional or non-lesional epilepsy were seizure free if scalp EEG revealed a focal beta discharge at ictal onset. Moreover, logistic regression analysis showed that focal ictal beta pattern and completeness of lesion resection were independently predictive of seizure-free outcome. Ictal onset with lateralized EEG activity of any kind and postresection electrocorticographic spikes did not predict surgical outcome (p > 0.05). CONCLUSIONS: Only about 25% of FLE surgical patients have a focal beta-frequency discharge at seizure onset on scalp EEG. However, its presence is highly predictive of excellent postsurgical seizure control in either lesional or non-lesional FLE surgical patients.

Child↗

PubMed1996

Microsurgical replantation of avulsed scalps.

Four cases of extensive scalp avulsion were successfully replanted in this reported series. All patients were female, with the youngest 3 years of age. All replanted scalps survived, with some marginal necrosis due to tissue destruction. Postoperative venous congestion of the involved ear in one patient was managed with anticoagulant therapy. Another patient underwent severe congestion of the whole replanted scalp and was treated with thin skin-graft shaving in the parietal area. In the follow-up period, all patients obtained hair growth in the scalp with light touch sensation.

Adult↗