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At least 55 records · Page 3Linked to original sources
PubMed2006

Compound elevated skull fracture: a forgotten type of skull fracture.

BACKGROUND AND OBJECTIVE: We report 4 patients who presented with a rare type of vault fracture. This form of fracture has only been described in few instances in the literature. CASE DESCRIPTION: All the patients presented with elevation of free skull fracture fragments. The etiologies were assault (1 patient), domestic accident (1 patient), and road traffic accident (2 patients). All the fractures were compound as in previously reported cases. Delay in surgery resulted in cerebral abscess in 1 patient. Surgery was performed in all the patients: wound debrident, duroplasty, and reduction of fracture in 3 patients and craniotomy with excision of abscess in 1 patient. Two of the patients did well after surgery. The patients with abscess died 9 days after surgery. Another patient developed CSF fistula after surgery, and died of aspiration while waiting for the closure of the fistula. CONCLUSION: Elevated skull fractures in our series were all compound fractures. Both long, sharp objects as well as blunt objects can cause this injury. Delay in surgery could result in intracranial sepsis. We suggest that this fracture should be included in the classification of skull fractures.

Adult↗
PubMed2003

Skull fracture as a herald of intracranial abnormality in children with mild head injury: is there a role for skull radiographs?

The aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X-rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1-year period was done. Three-hundred and eighty-one patients were included with a mean age of 6 years. Thirty-one percent of patients had intracranial abnormality. Forty-nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty-five percent of patients with drainable collections had associated fractures. Twenty-three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of 'silent' drainable collections.

Adolescent↗
PubMed2001

Prevention of postoperative complications in skull base surgery for nasal or paranasal sinus carcinoma invading the skull base.

With recent technical advances in skull base surgery, radical resection of a nasal or paranasal sinus carcinoma invading the skull base can now be achieved. To assure a satisfactory surgical result, it is essential to prevent postoperative infection. In our series of 14 cases, serious postoperative infections occurred in the earliest 10 cases, and only 2 of these patients are still alive. The vascularised abdominal muscle flap for skull base reconstruction was fixed with fibrin glue, but was not adequate to fill the dead space, resulting in cerebrospinal fluid leakage and subsequent meningitis. Once the infection occurred, a free bone flap became the focus of infection. Based on these earlier experiences, we used a ROC fastener system to completely fill the dead space with an abdominal muscle flap, and bone flap was primarily craniectomised in the four most recent cases. With this technique, there were no postoperative infections.

Abdominal Muscles↗
PubMed1994

Pituitary adenoma invading the skull base--a strategy for skull base surgery.

A strategy for surgical management, including the approach and preoperative evaluation, of pituitary adenoma invading the skull base is described. Preoperative evaluation requires a balloon occlusion test of the internal carotid artery (ICA) to determine tolerance to occlusion. Failure to tolerate occlusion indicates administration of brain protective agents and/or a bypass procedure before tumor removal. The transsphenoidal, pterional, orbitofrontomalar, and infratemporal fossa approaches are all suitable for various tumor locations. A combined orbitofrontomalar and extended frontal approach allows removal of tumor with extensive invasion and is suitable for bypass procedures. Preoperative evaluation of ICA occlusion can prevent development of hemodynamic stroke. We treated five patients with pituitary adenoma invading the skull base, including two primary and three recurrent cases. All symptoms improved, but temporary oculomotor nerve disturbance occurred in three patients and anosmia in one. Reoperations for recurrent pituitary adenomas were effective in reversing the symptoms. No hemodynamic stroke was seen postoperatively. These tumors, except for drug-responsive cases, are indicated for skull base surgery.

Adenoma↗
PubMed1997

Long-term outcome of extensive skull reconstruction using demineralized perforated bone in Siamese twins joined at the skull vertex.

The successful use of cortical demineralized perforated bone in the treatment of extensive skeletal defects in children is exemplified by this case involving Siamese twins joined at the skull vertex. Four years following extensive skull reconstruction using demineralized perforated bone, an examination revealed successful calvarial reconstruction in one twin. The other twin required additional implants of demineralized perforated bone to fill in defects. However, a histologic examination taken following this additional procedure revealed that these implants neither caused tissue reaction over a 4-year period, nor showed signs of resorption. Bony remodeling and new bone formation were in progress. Compared with other bone substitutes, demineralized perforated bone has proven to be effective in the treatment of large skull defects in children.

Bone Demineralization Technique↗
PubMed1993

Role of brachytherapy in the management of the skull base meningioma. Treatment of skull base meningiomas.

BACKGROUND: The treatment of primary and recurrent skull base meningiomas presents a formidable surgical problem. METHODS: Fifteen patients with primary and recurrent skull base meningiomas were treated by means of interstitial irradiation with iodine 125 (125I) seed implantation. The physical characteristics of 125I enabled the authors to administer a minimum tumor dose ranging from 100 to 500 Gy at a low dose rate of 0.05-0.25 Gy per hour. RESULTS: All 15 patients are alive at a median follow-up of 29 months. Of the 15 patients, 2 with calcification and 2 without calcification achieved only partial responses. The remaining 11 patients achieved a complete response. No early or late complications were observed. CONCLUSIONS: From these data, the authors conclude that interstitial irradiation with 125I seeds is an effective, safe, and simple method in the treatment of both recurrent and primary skull base meningiomas.

Adult↗
PubMed1999

Adult growing skull fracture mimicking a skull tumor.

Growing skull fractures (GSF) are rare in adults. We report the case of an adult who was found to have a GSF 50 years after head trauma. This case highlights the need to consider GSFs in the differential diagnosis of adults with intradiploic skull lesions.

Craniocerebral Trauma↗
PubMed1999

The form of the supraorbital margin as a criterion in identification of sex from the skull: investigations based on modern human skulls.

Sexual dimorphism in the shape of the supraorbital margin was reported by Broca and various subsequent authors, but no consistently applied, precise definition has been established. In this study of modern human skulls, the value of our definition of the sex-related difference in this area in the identification of sex from the skull was investigated. It was found that this feature can be assessed reliably, is strongly related to sex, and is independent of the side. The accuracy of identification of sex using this method alone was found to be about 70%.

Female↗
PubMed2007

Sarcoidosis presenting as an osteolytic skull lesion: a case report and review of literature on skull sarcoidosis.

Bone sarcoidosis of the skull is an infrequent presentation of sarcoidosis. We describe a 51-year-old man who consulted due to inflammatory-appearing nodulation in the right supraorbital region. Images showed a solitary osteolytic lesion extending to soft tissues with increased scintigraphic uptake. The anatomopathological study revealed the presence of non-caseating epithelioid granulomas, compatible with sarcoidosis. Steroid treatment led to a marked remission of the lesion, without evidence of relapse during a follow-up period of 1 year. The literature dealing with skull sarcoidosis is reviewed.

Biopsy↗
PubMed2001

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan.

We analyzed 143 cases of skull base surgery collected from the eight institutions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by olfactory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The most frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8). For repair of dura matter, fascia lata was used in 37 cases. galeopericranial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65%) in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 10), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malignant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease. Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases. liquorrhea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral thrombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large enough database for comparison of results, and prognosis for each histological entity and further define the role of multidisciplinary treatment.

Adult↗
PubMed1992

Studies on the parietal region of the cervid skull. II. The parietooccipital region in the skull of the fallow deer (Dama dama L.).

In contrast to the situation in roe deer (Kierdorf and Kierdorf, in press) and other cervid species, an os interparietale was missing in the fallow deer cranium. Absence of this skull element in Dama dama is regarded as an apomorphic character state. The area covered by the interparietals in Capreolus was occupied by the parietals in Dama. This condition (loss of interparietals, enlargement of parietals) is in accord with a trend seen in vertebrate evolution, that is, progressive reduction in the number of skull elements concomitant with enlargement of the remaining bones. Synostosis of the parietals in Dama started a few days post partum and was completed at about 7 to 8 months of age. In males, obliteration of the sutura parietooccipitalis commenced in adult life, whereas in females only closure of the central region of this suture was occasionally observed.

Animals↗
PubMed1987

Autogeneic skull bone grafts to reconstruct large or complex skull defects in children and adolescents.

Autogeneic split or free skull bone grafts harvested at the time of operation were used to repair large or complex skull defects in 19 children; in 2 children, autogeneic fresh rib grafts were also used. Follow-up examinations for periods of 1 and 7 years showed that the use of autogeneic grafts is superior to the use of materials such as acrylic or metals for cranioplasty in children.

Adolescent↗
PubMed1999

[Assymetric skull? Early correct diagnosis is a must! Positional skull deformities can be avoided].

During the past few years the supine sleeping position has successfully been reintroduced for infants in order to prevent sudden infant death syndrome. However, the change in sleeping position has not been accompanied by a soft pillow under the infants head, which has probably caused a higher incidence of acquired skull deformities. These positional skull deformities need to be prevented or treated.

Craniosynostoses↗
PubMed1991

[The angulation of the base of the skull--a determining factor for facial skeletal development? The significance of the angulation of the base of the skull].

By means of tensor analysis this cephalometric study was undertaken to compare the growth differences of the facial skull of untreated orthodontic patients. We investigated children with small cranial base angle (BaSN = 128-132 degrees) and another group with an angle greater than 132 degrees. In this cross-sectional study we compared the development of the skull from an age of 7 to 8 years to an age of 9 to 10 years. In contrast to patients with small cranial base angle those with flatter base showed an increased vertical growth. The growth of the midface and mandible tend toward a retrognathic face. Angle Cl.-I cases showed a proportional horizontal growth pattern in all regions of the face.

Cephalometry↗
PubMed1986

[Clarification of basic factors of the morphology of the skull, especially ontogenesis of the skull of Cavia aperea f. porcellus L].

Skull morphology cannot be understood without consideration of its ontogenetic morphogenesis. Meaningful comparisons of vertebrate crania must include these developmental processes. The criteria and methods for descriptions and comparisons were originally established by Ernst Gaupp and others around the beginning of this century. Nevertheless, the complete course of cranial morphogenesis from the first precartilaginous blastemata to the adult cranium has never been described in any vertebrate species, so far. Dierbach (1985a, b) intended to contribute to the knowledge of morphogenesis of the cranium of Cavia. His paper is based on a deficient reconstruction of the cranium of an embryo of 36 mm crown-rump-length. As the description follows Zimmerman's (1976) description of an 55 mm CRL-stage, the characteristics of the 36 mm stage are missed. New findings are not reported. The paper does not include reconstruction of the process of morphogenesis of the cranium or of any of its structures. A new morphological interpretation of the Foramen infraorbitale of Cavia is not substantiated. Literature is cited unreliably. For comparisons with other species or for the reconstruction of cranial morphogenesis of Cavia on the basis of the results of several previous authors Dierbach's papers cannot be used, because of many inconsistencies in terminology and definitions. Frick (1954) and Zeller (1983), both cited by Dierbach, partially differ in their respective interpretation of the morphogenesis of the Fenestra rotunda of mammals. Dierbach's discussion does not proceed beyond Voit (1909). Morphology of the Ala temporalis is discussed controversially in recent papers. Dierbach remains at the state of knowledge of Gaupp (1902). Authors such as Broom (1908), Fuchs (1915), and Gregory (1913) already have shown that the palatoquadrate participates in the formation of the Ala temporalis of mammals. The alisphenoid can be recognized in fig. 3 of Dierbach (1985 a). However, it is not mentioned in the caption or in the text. Therefore, the problem of the secondary lateral wall of the braincase of mammals in the orbitotemporal region of the skull cannot be discussed by Dierbach. No problems of cranial morphology are raised or discussed.

Animals↗
PubMed1987

[3-dimensional (3-D) image reconstruction of the facial skull and skull base in computerized tomography].

The diagnostic value of three-dimensional (3-D) image reconstruction in conditions affecting the craniofacial skeleton and the skull base has been assessed and the results compared with the CT scans used. Owing to reconstruction artefacts and some limitations in the exact display of 3-D images, no substantial improvement in diagnosis can be expected. Nonetheless, 3-D images facilitate the analysis and detection of complex fractures of the craniofacial skeleton and improve surgical planning and postoperative evaluation.

Facial Bones↗
PubMed2005

What can a baby's skull withstand? Testing the skull's resistance on an anatomical preparation.

A fall scenario is often given to explain the reason for a head injury to an infant. Mostly the examining doctor or forensic expert has to rely on his own experience and to appraise the situation to be consistent or not with his finds. An experiment carried out on an anatomical preparation showed that the skull of a newborn baby was able to repeatedly resist forces of up to 1000 N before breaking in. Even then the fracture lines followed the bony spikes (spiculae) from the ossification centers of the skull bones. If fractures are running across these spiculae there is reason to believe that high local force has been used, and a blow against a sharp edge must be considered.

Accidental Falls↗