WorldWideScience

Sample records for anterior skull base

  1. Surgical technique for repair of complex anterior skull base defects

    Directory of Open Access Journals (Sweden)

    Kevin Reinard

    2015-01-01

    Conclusion: The layered reconstruction of large anterior cranial fossa defects resulted in postoperative CSF leak in only 5% of the patients and represents a simple and effective closure option for skull base surgeons.

  2. Minimally invasive surgery of the anterior skull base: transorbital approaches

    Science.gov (United States)

    Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl-Michael

    2016-01-01

    Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. PMID:27453759

  3. Anterior and middle skull base reconstruction after tumor resection

    Institute of Scientific and Technical Information of China (English)

    WANG Bo; WU Sheng-tian; LI Zhi; LIU Pi-nan

    2010-01-01

    Background Surgical management of skull base tumors is still challenging today due to its sophisticated operation procedure. Surgeons who specialize in skull base surgery are making endeavor to promote the outcome of patients with skull base tumor. A reliable skull base reconstruction after tumor resection is of paramount importance in avoiding life-threatening complications, such as cerebrospinal fluid leakage and intracranial infection. This study aimed at investigating the indication, operation approach and operation technique of anterior and middle skull base reconstruction.Methods A retrospective analysis was carried out on 44 patients who underwent anterior and middle skull base reconstruction in the Department of Neurosurgery at Beijing Tiantan Hospital between March 2005 and March 2008. Different surgical approaches were selected according to the different regions involved by the tumor. Microsurgery was carried out for tumor resection and combined endoscopic surgery was performed in some cases. According to the different locations and sizes of various defects after tumor resection, an individualized skull base soft tissue reconstruction was carried out for each case with artificial materials, pedicled flaps, free autologous tissue, and free vascularized muscle flaps, separately. A skull base bone reconstruction was carried out in some cases simultaneously.Results Soft tissue reconstruction was performed in all 44 cases with a fascia lata repair in 9 cases, a free vascularized muscle flap in 1 case, a pedicled muscle flap in 14 cases, and a pedicled periosteal flap in 20 cases. Skull base bone reconstruction was performed on 10 cases simultaneously. The materials for bone reconstruction included titanium mesh, free autogenous bone, and a Medpor implant. The result of skull base reconstruction was satisfactory in all patients. Postoperative early-stage complications occurred in 10 cases with full recovery after conventional treatment.Conclusions The specific

  4. A checklist for endonasal transsphenoidal anterior skull base surgery.

    Science.gov (United States)

    Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

    2016-06-01

    OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management

  5. A Case of Multiple Primary Tumors of the Anterior Skull Base

    OpenAIRE

    Lenarz, Minoo; Durisin, Martin; Becker, Hartmut; Brandis, Almuth; Lenarz, Thomas

    2007-01-01

    We report a case of synchronous olfactory bulb meningioma and undifferentiated carcinoma of the nose and paranasal sinuses that involved and destroyed the anterior skull base and mimicked intracranial invasion by a carcinoma. The heterogeneity of tissue types in the skull base gives rise to a diverse variety of benign and malignant neoplasms which have totally different prognoses. Synchronous development of benign and malignant primary tumors both originating from and involving the skull base...

  6. Chondroblastoma with secondary aneurysmal bone cyst in the anterior skull base

    OpenAIRE

    Ming Jie Wang, MD, PhD; Bing Zhou, MD

    2016-01-01

    Chondroblastoma with secondary aneurysmal bone cyst (ABC), especially in the anterior skull base, is an extremely rare condition. A 5-year-old boy presented with a large space-occupying lesion in the anterior skull base along with a left sided-epistaxis, proptosis and decreased vision. Radical excision of the lesion was performed by an endoscopic transnasal and transethmoidal approach. The patient recovered without any recurrence during a follow-up period of up to 28 months. Here, we review t...

  7. Quality-of-Life after Anterior Skull Base Surgery: A Systematic Review.

    Science.gov (United States)

    Kirkman, Matthew A; Borg, Anouk; Al-Mousa, Alaa; Haliasos, Nikolaos; Choi, David

    2014-04-01

    Background Improved treatment and survival of patients with skull base tumors has made the assessment of quality-of-life (QoL) in this population increasingly important. This article provides a comprehensive systematic review pertaining to QoL assessment in adults undergoing anterior skull base surgery. Methods We performed a literature search using the electronic databases of Ovid Medline and Embase. Additional articles were identified through a search using the phrase anterior skull base. Further articles were sought through hand-searching relevant journals and reference lists of identified articles. Results Our search strategy identified 29 articles for inclusion in our systematic review, with considerable variation between studies in population characteristics, methodological design and quality, follow-up length, and outcome assessment. The most commonly used QoL tools were the Karnofsky Performance Status and the Anterior Skull Base Questionnaire. QoL following anterior skull base surgery appears to improve beyond preoperative levels in the months after surgery. For patients undergoing endoscopic skull base surgery, the gain in QoL appears to be greater and may manifest earlier, with no clear long-term deleterious effect on sinonasal outcomes compared with open surgery. Conclusions QoL after anterior skull base surgery in adults appears to improve within several months of surgery, but earlier and to a larger extent if the endoscopic approach is used. Given the relative paucity and heterogeneity of anterior skull base tumors, large-scale prospective multicentre studies utilizing valid and reliable multidimensional QoL tools are required. This may result in improved patient care, by understanding patients' needs better and facilitating the provision of reliable outcome data for clinical trials. PMID:24719794

  8. Postnatal development of the anterior skull base and nasal septum: CT study

    International Nuclear Information System (INIS)

    To know the normal CT appearance of the anterior skull base and nasal septum after birth. Coronal CT scans with a helical mode were performed from the nasal bone to the sphenoid sinus in 99 children whose ages ranged from 27 days to 14 years. We investigated the CT appearance of the developing anterior skull base and nasal septum with particular attention to the anteroposterior length of the anterior skull base and the ossification patterns of the cribriform plate, perpendicular plate, crista galli, and vomer. The anteroposterior length of the anterior skull base statistically significantly increased with age. The cribriform plate showed partial or complete ossification in at least one segment at more than 3 months of age and in all three segments at more than 6 months of age. Ossification of the cribriform plate occurred earlier in the middle segment than in the anterior and posterior segments. It began exclusively in the region of the lateral mass of the ethmoid and proceeded medially toward the crista galli. Partial ossification of the perpendicular plate was noted as early as 9 months of age, and complete ossification as early as 13 months of age. All children at 18 months and older showed at least partial ossification of the perpendicular plate. Partial ossification of the crista galli was noted as early as 27 days of age, and complete ossification as early as 3 months of age. CT showed complete ossification of the crista galli in all but two children at 6 months and older. The superior aspect of the vomer exhibited a V- or Y-shape on all CT scans in 66%(65/99) of children at any age. It appeared as an undivided single lump anteriorly and a V or Y posteriorly in 34%(34/99). Knowledge of the normal developing patterns of ossification of the anterior skull base and nasal septum could help prevent errors in interpreting CT scans in this region, especially in infants and young children

  9. Orbito-Rhino-Antro Access Osteotomy For Anterior Skull Base Lesions

    OpenAIRE

    Sreeramaneni, Sumanth K; Kattimani, Vivekanand. S

    2014-01-01

    Even with advent of endoscopic assisted surgeries the access osteotomy plays an important role for accessing the pathological lesions of anterior skull base since beginning of the era of surgery. This report introduces the orbito–rhino–antral access osteotomy for the removal of juvenile nasio angio fiboma extending in to the cranial base. This osteotomy provides good access to the lesion with lesser morbidity and without hampering the occlusion as in lefort osteotomies. It is safe, easy and f...

  10. Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors

    DEFF Research Database (Denmark)

    Astradsson, Arnar; Wiencke, Anne Katrine; Munck af Rosenschold, Per; Engelholm, Svend-Aage; Ohlhues, Lars; Roed, Henrik; Juhler, Marianne

    2014-01-01

    meningiomas and 100, 98.2 and 94.9% for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were......To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior...... skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found...

  11. Primary step for endoscopic sinonasal tract and anterior skull base robotics

    Directory of Open Access Journals (Sweden)

    Crampette Louis

    2011-12-01

    Full Text Available Introduction: Surgeons have evolved a lot their surgical procedures in sinus surgery and are now able to resect malignant tumors. These progresses are now leading new difficulties like impairing vision (bleeding and LCR flow and necessity of multiple simultaneous tasks. With the aim of designing a new endoscope-holder, primary step was to characterize the surgeon gesture, the kinematics, and the type of man-machine interface acceptable by the surgeon. Methods: We worked on thirteen sinonasal tracts of cadaver heads. Surgical procedures were: opening all the sinuses, the carotid, the sella turcica, the lamina papyracea and the anterior skull base. We used conventional instruments which were instrumented with a force-torque sensor and a navigation system. Then we have experimentally evaluated robots with three different kinematics and two types of man-machine interfaces. Results: We collected enough position and force data as well as kinematics constraints and interface requirements to specify a robot for endoscopic sinus surgery.

  12. A prospective evaluation of short-term health-related quality of life in patients undergoing anterior skull base surgery.

    Science.gov (United States)

    Abergel, Abraham; Fliss, Dan M; Margalit, Nevo; Gil, Ziv

    2010-01-01

    We evaluated the health-related quality of life (QOL) of patients undergoing anterior skull base tumor resection. The Anterior Skull Base Surgery QOL questionnaire, a disease-specific multidimensional instrument dedicated to this population, was used to collect and prospectively analyze demographic, medical, and QOL data on 48 patients. Thirty-nine patients completed the questionnaire preoperatively and at 6 and 12 months postoperatively. Seventeen patients (44%) had malignant histology and 22 (56%) had benign tumors. The overall QOL score decreased significantly at 6 months postoperatively (p base tumor resection returns to baseline by 1 year after surgery. Histology and radiotherapy are significant predictors of health-related QOL in this population. PMID:20592855

  13. THIRTY YEARS IN SKULL BASE SURGERY

    Institute of Scientific and Technical Information of China (English)

    HUANG; Deliang; LIU; Liangfa

    2012-01-01

    <正>The skull base generally refers to the anterior, middle and posterior cranial fossa and structures on the outside side of these skull areas. The cranial roof and skull base are separated by a line connecting the external occipital protuberance, parietal notch and supraorbital ridge[1].The skull base supports the brain above, is connected to

  14. Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway

    International Nuclear Information System (INIS)

    To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway. We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses. At a median follow-up of 13 months (range, 2–36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6–27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up. Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway

  15. Surgical Simulation of Extradural Anterior Clinoidectomy through the Trans-superior Orbital Fissure Approach Using a Dissectable Three-dimensional Skull Base Model with Artificial Cavernous Sinus

    OpenAIRE

    Mori, Kentaro; Yamamoto, Takuji; NAKAO, Yasuaki; Esaki, Takanori

    2010-01-01

    Extradural anterior clinoidectomy via the trans-superior orbital fissure (SOF) approach can provide extensive exposure of the anterior clinoid process and safe drilling under direct view. This technique requires peeling of the dura propria of the temporal lobe from the lateral wall of the SOF. Therefore, cadaveric dissection is mandatory to acquire surgical technique. However, chances for cadaveric dissection are limited. We propose modification of our three-dimensional (3-D) skull base model...

  16. Skull Base Tumors

    Science.gov (United States)

    Schulz-Ertner, Daniela

    In skull base tumors associated with a low radiosensitivity for conventional radiotherapy (RT), irradiation with proton or carbon ion beams facilitates a safe and accurate application of high tumor doses due to the favorable beam localization properties of these particle beams. Cranial nerves, the brain stem and normal brain tissue can at the same time be optimally spared.

  17. Skull base bone hyperpneumatization

    OpenAIRE

    Houet, E J; Kouokam, L.M.; Nchimi, A L

    2013-01-01

    A 50-year-old male with a long standing history of compulsive Valsalva maneuvers, complaining of episodes of vertigo underwent head computed tomography. Axial CT slices at the level of the skull base (Fig. A) and the first cervical vertebrae (Fig. B) shows an extensive unusual pneumatization of both the body and lateral processes of the first cervical vertebrae (arrows), with air pouches dissecting planes between bone cortex and the periosteum around the occipital bone and the lateral process...

  18. Skull base tumors; Tumoren der Schaedelbasis

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F.; Naumann, N.; Grunwald, I.; Reith, W. [Klinik fuer Diagnostische und Interventionelle Neuroradiologie des Universitaetsklinikums des Saarlandes, Homburg/Saar (Germany); Nabhan, A.; Shariat, K. [Neurochirurgische Klinik des Universitaetsklinikums des Saarlandes, Homburg/Saar (Germany)

    2005-09-01

    Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented. (orig.) [German] Die moderne Bildgebung hat einen besonderen Stellenwert bei der Diagnostik und Therapie von Schaedelbasispathologien. Zahlreiche Laesionen koennen anhand ihrer CT- und MRT-Befunde, insbesondere unter Beruecksichtigung ihrer genauen Lokalisation, artdiagnostisch eingeordnet werden. Im Bereich der vorderen Schaedelbasis sind v. a. Karzinome, Rhabdomyosarkome, Aesthesioneuroblastome und Meningeome vorzufinden. Im Bereich der mittleren Schaedelbasis ist in erster Linie an nasopharyngeale Karzinome, Karzinommetastasen, Meningeome, Hypophysenadenome und Neurinome zu denken. Zu den haeufigsten Tumoren der hinteren Schaedelgrube, unter Einschluss des Kleinhirnbrueckenwinkels, gehoeren Neurinome, Meningeome, nasopharyngeale Karzinome, Karzinommetastasen, Chordome und Paragangliome. Eine wichtige Aufgabe der Schnittbildgebung liegt in der Bestimmung der exakten Tumorausdehnung und in der Beurteilung der Lagebeziehung des Tumors zu den komplexen anatomischen Strukturen wie Hirnnerven und

  19. Three-dimensional MR imaging of skull-base tumors

    International Nuclear Information System (INIS)

    This paper demonstrates skull base lesions and to evaluate the diagnostic value of three-dimensional (3D) MR imaging performed with 3D reconstruction of the head. MR imaging was performed at 1.0 T and a 1.5 T, M before and after application of Gd-DTPA. Twenty-one healthy volunteers and 19 patients with skull base lesions were examined with standard 2D MR imaging and 3D fast low-angle shot imaging. A 3D reconstruction mode, based on the ray-tracing model, enabled us to construct arbitrarily complex extraction schemes. All 3D-reconstructions were compared with the surgical findings. The diagnoses included 10 benign skull base lesions and nine malignant lesions of the anterior and middle skull base. Gd-DTPA proved helpful in 82% of the cases

  20. Management of osteomyelitis of the skull base

    International Nuclear Information System (INIS)

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol

  1. Management of osteomyelitis of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Benecke, J.E. Jr. (Otologic Medical Group, Inc., Los Angeles, CA (USA))

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

  2. Management of osteomyelitis of the skull base.

    Science.gov (United States)

    Benecke, J E

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol. PMID:2601534

  3. CT skull base & calvarium normal variant pitfalls

    OpenAIRE

    Lockwood, P

    2013-01-01

    Intended learning outcomes - To recognise the varied neurological appearances of skull based normal variants with the brain. Highlighting the importance of differentiation of normal and variant anatomy from the pitfalls of misdiagnosing a pathological condition Content of Presentation -Pictorial review of 12 common examples of neuroradiological normal variant conditions of skull base and calvarium anatomical areas of the brain, including sutures, asymmetry of bones, benign growths, thicken...

  4. Radiologic assessment of maxillofacial, mandibular, and skull base trauma

    International Nuclear Information System (INIS)

    Cranio-maxillofacial injuries affect a significant proportion of trauma patients either in isolation or concurring with other serious injuries. Contrary to maxillofacial injuries that result from a direct impact, central skull base and lateral skull base (petrous bone) fractures usually are caused by a lateral or sagittal directed force to the skull and therefore are indirect fractures. The traditional strong role of conventional images in patients with isolated trauma to the viscerocranium is decreasing. Spiral multislice CT is progressively replacing the panoramic radiograph, Waters view, and axial films for maxillofacial trauma, and is increasingly being performed in addition to conventional films to detail and classify trauma to the mandible as well. Imaging thus contributes to accurately categorizing mandibular fractures based on location, into alveolar, mandibular proper, and condylar fractures - the last are subdivided into intracapsular and extracapsular fractures. In the midface, CT facilitates attribution of trauma to the categories central, lateral, or combined centrolateral fractures. The last frequently encompass orbital trauma as well. CT is the imaging technique of choice to display the multiplicity of fragments, the degree of dislocation and rotation, or skull base involvement. Transsphenoid skull base fractures are classified into transverse and oblique types; lateral base (temporal bone) trauma is subdivided into longitudinal and transverse fractures. Supplementary MR examinations are required when a cranial nerve palsy occurs in order to recognize neural compression. Early and late complications of trauma related to the orbit, anterior cranial fossa, or lateral skull base due to infection, brain concussion, or herniation require CT to visualize the osseous prerequisites of complications, and MR to define the adjacent brain and soft tissue involvement. (orig.)

  5. Skull base development and craniosynostosis

    Energy Technology Data Exchange (ETDEWEB)

    Blaser, Susan I. [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Division of Neuroradiology, Toronto (Canada); University of Toronto, Department of Otolaryngology - Head and Neck Surgery, Toronto (Canada); Padfield, Nancy [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Division of Neuroradiology, Toronto (Canada); Chitayat, David [The Hospital for Sick Children and University of Toronto, Division of Clinical and Metabolic Genetics, Toronto (Canada); Mount Sinai Hospital and University of Toronto, Prenatal Diagnosis and Medical Genetics Program, Toronto (Canada); Forrest, Christopher R. [The Hospital for Sick Children and University of Toronto, Centre for Craniofacial Care and Research, Division of Plastic and Reconstructive Surgery, Toronto (Canada)

    2015-09-15

    Abnormal skull shape resulting in craniofacial deformity is a relatively common clinical finding, with deformity either positional (positional plagiocephaly) or related to premature ossification and fusion of the skull sutures (craniosynostosis). Growth restriction occurring at a stenosed suture is associated with exaggerated growth at the open sutures, resulting in fairly predictable craniofacial phenotypes in single-suture non-syndromic pathologies. Multi-suture syndromic subtypes are not so easy to understand without imaging. Imaging is performed to define the site and extent of craniosynostosis, to determine the presence or absence of underlying brain anomalies, and to evaluate both pre- and postoperative complications of craniosynostosis. Evidence for intracranial hypertension may be seen both pre- and postoperatively, associated with jugular foraminal stenosis, sinovenous occlusion, hydrocephalus and Chiari 1 malformations. Following clinical assessment, imaging evaluation may include radiographs, high-frequency US of the involved sutures, low-dose (20-30 mAs) CT with three-dimensional reformatted images, MRI and nuclear medicine brain imaging. Anomalous or vigorous collateral venous drainage may be mapped preoperatively with CT or MR venography or catheter angiography. (orig.)

  6. Skull base development and craniosynostosis

    International Nuclear Information System (INIS)

    Abnormal skull shape resulting in craniofacial deformity is a relatively common clinical finding, with deformity either positional (positional plagiocephaly) or related to premature ossification and fusion of the skull sutures (craniosynostosis). Growth restriction occurring at a stenosed suture is associated with exaggerated growth at the open sutures, resulting in fairly predictable craniofacial phenotypes in single-suture non-syndromic pathologies. Multi-suture syndromic subtypes are not so easy to understand without imaging. Imaging is performed to define the site and extent of craniosynostosis, to determine the presence or absence of underlying brain anomalies, and to evaluate both pre- and postoperative complications of craniosynostosis. Evidence for intracranial hypertension may be seen both pre- and postoperatively, associated with jugular foraminal stenosis, sinovenous occlusion, hydrocephalus and Chiari 1 malformations. Following clinical assessment, imaging evaluation may include radiographs, high-frequency US of the involved sutures, low-dose (20-30 mAs) CT with three-dimensional reformatted images, MRI and nuclear medicine brain imaging. Anomalous or vigorous collateral venous drainage may be mapped preoperatively with CT or MR venography or catheter angiography. (orig.)

  7. Sinonasal Non-Hodgkin's Lymphoma with Skull Base Involvement

    OpenAIRE

    Dare, Amos O.; Datta, Rajiv V.; Thom R. Loree; Hicks, Wesley L.; Grand, Walter

    2001-01-01

    Non-Hodgkin's lymphoma (NHL) is a rare tumor of the skull base. As the incidence of primary central nervous system (CNS) lymphoma has increased, atypical presentations involving the skull or cranial base exclusively have been reported. In immunocompetent patients with no previous history or predisposing factors, the diagnosis of primary NHL of the skull base may be delayed. We present four cases of nasal and paranasal sinus NHL with both skull base and intracranial involvement in immunocompet...

  8. Osteoradionecrosis of the maxilla and skull base

    Energy Technology Data Exchange (ETDEWEB)

    Komisar, A.; Silver, C.; Kalnicki, S.

    1985-01-01

    Osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing.

  9. Osteoradionecrosis of the maxilla and skull base

    International Nuclear Information System (INIS)

    Osteoradionecrosis of the maxilla and base of skull are rare phenomena, usually seen after combined therapy for malignancies of the maxillary sinus. While the mandible is most commonly affected by osteoradionecrosis, the maxilla and skull base may also be affected when preoperative or postoperative radiotherapy is combined with surgery. Contributing factors may be: high radiation dosage delivered to the treatment volume (greater than 6000 rads), loss of tissue protective effects due to surgery, decreased vascularity caused by surgery and radiation, and proximity of a contaminated field. Onset of symptoms may vary. One patient presented 25 years after postoperative radiotherapy. Major symptoms were pain, trismus, and purulent discharge. The best diagnostic modality remains the history and physical exam, as the area is readily accessible. CT scans may be helpful in diagnosis and treatment planning. Therapy should follow time honored principles of local wound care. Home irrigations and hyperbaric therapy have been helpful in encouraging early sequestration and rapid healing

  10. Carbon ion radiotherapy of skull base chondrosarcomas

    International Nuclear Information System (INIS)

    Purpose: To evaluate the effectiveness and toxicity of carbon ion radiotherapy in chondrosarcomas of the skull base. Patients and Methods: Between November 1998 and September 2005, 54 patients with low-grade and intermediate-grade chondrosarcomas of the skull base have been treated with carbon ion radiation therapy (RT) using the raster scan technique at the Gesellschaft fuer Schwerionenforschung in Darmstadt, Germany. All patients had gross residual tumors after surgery. Median total dose was 60 CGE (weekly fractionation 7 x 3.0 CGE). All patients were followed prospectively in regular intervals after treatment. Local control and overall survival rates were calculated using the Kaplan-Meier method. Toxicity was assessed according to the Common Terminology Criteria (CTCAE v.3.0) and Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) score. Results: Median follow-up was 33 months (range, 3-84 months). Only 2 patients developed local recurrences. The actuarial local control rates were 96.2% and 89.8% at 3 and 4 years; overall survival was 98.2%at 5 years. Only 1 patient developed a mucositis CTCAE Grade 3; the remaining patients did not develop any acute toxicities >CTCAE Grade 2. Five patients developed minor late toxicities (RTOG/EORTC Grades 1-2), including bilateral cataract (n = 1), sensory hearing loss (n = 1), a reduction of growth hormone (n = 1), and asymptomatic radiation-induced white matter changes of the adjacent temporal lobe (n = 2). Grade 3 late toxicity occurred in 1 patient (1.9%) only. Conclusions: Carbon ion RT is an effective treatment for low- and intermediate-grade chondrosarcomas of the skull base offering high local control rates with low toxicity

  11. Carbon Ion Radiotherapy for Skull Base Chordoma

    OpenAIRE

    Mizoe, Jun–etsu; Hasegawa, Azusa; Takagi, Ryo; Bessho, Hiroki; Onda, Takeshi; Tsujii, Hirohiko

    2009-01-01

    Objective: To present the results of the clinical study of carbon ion radiotherapy (CIRT) for skull base and paracervical spine tumors at the National Institute of Radiological Sciences in Chiba, Japan. Methods: The study is comprised of three protocols: a pilot study, a phase I/II dose escalation study, and a phase II study. All the patients were treated by 16 fractions for 4 weeks with total doses of 48.0, 52.8, 57.6, and 60.8 Gy equivalents (GyE). Results: As a result of the dose escalatio...

  12. Osteomyelitis of the base of the skull

    Energy Technology Data Exchange (ETDEWEB)

    Chandler, J.R.; Grobman, L.; Quencer, R.; Serafini, A.

    1986-03-01

    Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

  13. Transnasal endoscopy-assisted skull base surgery.

    Science.gov (United States)

    Stamm, Aldo M

    2006-09-01

    Skull base surgery (SBS), which originated in the 19th century, became refined in the 20th century in parallel with technological advancements and is now in the midst of further refinements largely driven by advances in endoscopic sinus surgery. With the development of modern SBS, lesions that were once inoperable and potentially fatal can now be eradicated successfully by means of endoscopy-assisted procedures that reduce or completely eliminate intracranial trauma, minimize postsurgical morbidity, and make full recovery possible. It is absolutely mandatory to have the appropriate instrumentation for endoscopy-assisted SBS. Among the new technologies available are advanced endoscopes, high-speed suction irrigation drills, digital video cameras, computed tomography and magnetic resonance imaging, and systems for 3-dimensional computer-assisted image-guided surgical navigation. An experienced endoscopic surgeon working with multidisciplinary teams, and using new instrumentation and techniques, can bring SBS to new levels of success in the 21st century. PMID:17040018

  14. Osteomyelitis of the base of the skull

    International Nuclear Information System (INIS)

    Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism

  15. Endoscopic endonasal skull base approach for parasellar lesions: Initial experiences, results, efficacy, and complications

    Directory of Open Access Journals (Sweden)

    Shigetoshi Yano

    2014-01-01

    Full Text Available Background: Endoscopic surgery is suitable for the transsphenoidal approach; it is minimally invasive and provides a well-lit operative field. The endoscopic skull base approach through the large opening of the sphenoid sinus through both nostrils has extended the surgical indication for various skull base lesions. In this study, we describe the efficacy and complications associated with the endoscopic skull base approach for extra- or intradural parasellar lesions based on our experiences. Methods: Seventy-four cases were treated by an endoscopic skull base approach. The indications for these procedures included 55 anterior extended approaches, 10 clival approaches, and 9 cavernous approaches. The operations were performed through both the nostrils using a rigid endoscope. After tumor removal, the skull base was reconstructed by a multilayered method using a polyglactin acid (PGA sheet. Results: Gross total resection was achieved in 82% of pituitary adenomas, 68.8% of meningiomas, and 60% of craniopharyngiomas in anterior extended approach and in 83.3% of chordomas in clival approach, but only in 50% of the tumors in cavernous approach. Tumor consistency, adhesion, and/or extension were significant limitations. Visual function improvements were achieved in 37 of 41 (90.2% cases. Cerebrospinal fluid (CSF leakage (9.5%, infections (5.4%, neural injuries (4.1%, and vascular injuries (2.7% were the major complications. Conclusions: Our experiences show that the endoscopic skull base approach is a safe and effective procedure for various parasellar lesions. Selection of patients who are unlikely to develop complications seems to be an important factor for procedure efficacy and good outcome.

  16. Endoscopic skull base training using 3D printed models with pre-existing pathology.

    Science.gov (United States)

    Narayanan, Vairavan; Narayanan, Prepageran; Rajagopalan, Raman; Karuppiah, Ravindran; Rahman, Zainal Ariff Abdul; Wormald, Peter-John; Van Hasselt, Charles Andrew; Waran, Vicknes

    2015-03-01

    Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts. PMID:25294050

  17. Esthetic Craniofacial Bony and Skull Base Reconstruction Using Flap Wrapping Technique.

    Science.gov (United States)

    Yano, Tomoyuki; Suesada, Nobuko; Usami, Satoshi

    2016-07-01

    For a safe and esthetic skull base reconstruction combined with repair of craniofacial bone defects, the authors introduce the flap wrapping technique in this study. This technique consists of skull base reconstruction using the vastus lateralis muscle of an anterolateral thigh (ALT) free flap, and structural craniofacial bony reconstruction using an autologous calvarial bone graft. The key to this technique is that all of the grafted autologous bone is wrapped with the vascularized fascia of the ALT free flap to protect the grafted bone from infection and exposure. Two anterior skull base tumors combined with craniofacial bony defects were included in this study. The subjects were a man and a woman, aged 18 and 64. Both patients had preoperative proton beam therapy. First, the skull base defect was filled with vastus lateralis muscle, and then structural reconstruction was performed with an autologous bone graft and a fabricated inner layer of calvarial bone, and then the grafted bone was completely wrapped in the vascularized fascia of the ALT free flap. By applying this technique, there was no intracranial infection or grafted bone exposure in these 2 patients postoperatively, even though both patients had preoperative proton beam therapy. Additionally, the vascularized fascia wrapped bone graft could provide a natural contour and prevent collapse of the craniofacial region, and this gives patients a better facial appearance even though they have had skull base surgery. PMID:27300454

  18. Transoral robotic surgery of the central skull base: preclinical investigations.

    Science.gov (United States)

    Fernandez-Nogueras, F J J; Katati, M J; Arraez Sanchez, M A; Molina Martinez, M; Sanchez Carrion, M

    2014-06-01

    In this study we explored possible applications of the da Vinci system in approaching the skull base at optic chiasm level on two cryopreserved cadavers, using an entirely transoral robotic technique (TORS). We used a standard 12 mm endoscopy and 8 mm terminals. Bone drilling was performed manually. The da Vinci system is equipped with very good illumination and 3D viewing, thus providing excellent vision and great maneuverability even in the less accessible areas of the skull. Our experience demonstrates that an entirely transoral skull base robotic approach to this complex anatomical region has many advantages as compared to traditional techniques. PMID:24077869

  19. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... for skull-base tumors. This innovative surgical procedure uses the nose as a natural orifice to remove ... approach through the nose traditionally, but with the use of the endoscope, we're able to push ...

  20. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... natural orifice to remove skull-base tumors. It's brain surgery without the surgical incisions required to remove ... quicker recovery with less blood loss than traditional brain surgery. OR-Live makes it easy for you ...

  1. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... there is less disruption of tissues. It keeps anatomy close to normal on the way in and ... because the CT can show us the bony anatomy, which -- which is critical for skull-base surgery. ...

  2. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... a natural orifice to remove skull-base tumors. It's brain surgery without the surgical incisions required to ... loss than traditional brain surgery. OR-Live makes it easy for you to learn more. Just click ...

  3. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... go back to the video. So could you explain to us again what we're seeing there, ... opening in the base of the skull. Just making sure all the bleeding, all that venous oozing, ...

  4. Osseointegrated Implant Applications in Cosmetic and Functional Skull Base Rehabilitation

    OpenAIRE

    Benscoter, Brent J.; Jaber, James J.; Kircher, Matthew L.; Marzo, Sam J.; Leonetti, John P.

    2011-01-01

    This study discusses the indications, outcomes, and complications in patients that underwent osseointegrated implantation for skull base rehabilitation. We conducted a retrospective review of eight patients with skull base defects who had undergone implantation of a facial prosthetic retention device ± bone-anchored hearing aid at a tertiary academic referral center. Descriptive analysis of applications, techniques, outcomes, and complications were reviewed. The majority of patients were male...

  5. Meningioma of the Posterior Skull Base

    OpenAIRE

    Biggs, Michael Thomas; Fagan, Paul A.; Sheehy, John P.R.; Bentivoglio, Peter J.; Doust, Bruce D.; Tonkin, John

    1991-01-01

    Combined intratemporal and cerebellopontine angle meningiomas are rejatively rare. There are unsolved problems with the stability of the skull and spine and the lower cranial nerves and there is a marked tendency for the tumor to involve the spinal cord. This article reports on five cases of combined intratemporal and cerebellopontine angle meningiomas.

  6. Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of ''minor'' sutures

    Energy Technology Data Exchange (ETDEWEB)

    Calandrelli, Rosalinda; D' Apolito, Gabriella; Gaudino, Simona; Stefanetti, Mariangela; Colosimo, Cesare [Universita Cattolica Sacro Cuore, Institute of Radiology, Rome (Italy); Massimi, Luca; Di Rocco, Concezio [Universita Cattolica Sacro Cuore, Institute of Neurosurgery, Rome (Italy)

    2014-10-15

    This study aims to identify the premature synostosis of ''major'' and ''minor'' sutures of the four ''sutural arches'' of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis. We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae. We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to ''major'' but also to ''minor'' suture synostosis of the lambdoid and parieto-squamosal arches. Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between ''major'' and ''minor'' skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches. (orig.)

  7. Central skull base lymphoma in children: MR and CT features

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hei-Kyung [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Cheon, Jung-Eun; Kim, In-One; Youn, Byung Jae; Jung, Ah Young; Shin, Su-Mi; Kim, Woo Sun; Yeon, Kyung Mo [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Seoul National University Hospital, Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), Seoul (Korea)

    2008-08-15

    Central skull base tumours are rare in children. To characterize the imaging features of central skull base lymphoma in children to aid its diagnosis. The authors reviewed the CT findings (available in three patients) and MR findings (available in four patients) in four patients (three boys, one girl; age 2-12 years) with pathologically proven lymphoma (two with Burkitt lymphoma, two with B-cell lymphoma) involving the central skull base. Tumour location and extent, MRI signal intensities, noncontrast CT attenuation, patterns of enhancement, and changes in adjacent structures were evaluated. All four tumours involved the sphenoid bone. In three patients, the tumour extended to the ethmoid sinus and both cavernous sinuses. All lesions were isointense solid masses on T2-weighted images and showed avid enhancement, except for one lesion with a focal necrosis. All tumours were associated with adjacent dural thickening. Non-contrast CT showed highly attenuating masses and permeative bone destruction in the central skull base. Lymphoma involving the central skull base in children is visualized as an isointense mass on T2-weighted MRI with marked contrast enhancement and adjacent dural thickening, and as a highly attenuating mass on noncontrast CT with permeative or erosive bone destruction patterns. (orig.)

  8. CT of the base of the skull in bacterial meningitis

    International Nuclear Information System (INIS)

    CT examinations of 42 cases of bacterial meningitis revealed in 38.1% of the cases relevant inflammatory processes at the base of the skull which were of significant importance for a transmitted infection. Such infections were: Sinusitis frontalis, ethmoidalis, maxillaris and sphenoidalis, mastoiditis or petrositis, suppurating mucocele, impression fracture, and an intracranially penetrated foreign body. Excepting the identification of fine fractures, conventional X-ray films were diagnostically superior. Hence, especially in the acute stages, special projections can be omitted, if CT is effected in the region of the osseous base of the skull. CT performed in inflammatory diseases of the brain must include the base of the skull, since this will yield reliable pointers to original focus of the inflammation requiring appropriate treatment and elimination. (orig.)

  9. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2011-09-15

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A {sup 99mT}c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  10. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    International Nuclear Information System (INIS)

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A 99mTc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  11. Skull-base Ewing sarcoma with multifocal extracranial metastases

    Directory of Open Access Journals (Sweden)

    Sumit Thakar

    2012-01-01

    Full Text Available Intracranial occurrence of Ewing sarcoma (ES is unusual, with a skull-base location being anecdotal. We report a 29-year-old man who presented with rapidly progressive ophthalmoplegia, and was found to be harboring an infiltrative lesion involving the sphenoid sinus, sella, and clivus. He underwent trans-sphenoidal decompression of the lesion which was histologically suggestive of ES. He developed paraparesis 2 weeks after commencing adjuvant therapy. Imaging revealed two thoracic extradural lesions and florid vertebral and pulmonary metastases. This is the first report in indexed literature of a primary intracranial ES on the skull-base with disseminated extracranial disease.

  12. The Flap Sandwich Technique for a Safe and Aesthetic Skull Base Reconstruction.

    Science.gov (United States)

    Yano, Tomoyuki; Okazaki, Mutsumi; Tanaka, Kentarou; Iida, Hideo

    2016-02-01

    For safe and reliable skull base reconstruction combined with repair of cranial bone defects, we introduce the flap sandwich technique in this study. A titanium mesh is often used to repair structural cranial bone defects because it has less donor site morbidity and is easy to handle. However, titanium mesh has disadvantages of exposure and infection postoperatively. To improve surgical outcomes, we applied the flap sandwich technique to 3 cases of skull base reconstruction combined with cranial bone defect repair. Two anterior skull base defects and 1 middle skull base defect were included in this study. The subjects were all women, aged 30, 58, and 62 years. One patient had former multiple craniotomies and another patient had preoperative radiotherapy. The flap sandwich technique involves structural cranial bone reconstruction with a titanium mesh and soft tissue reconstruction with a chimeric anterolateral thigh free flap. First, the dead space between the repaired dura and the titanium mesh is filled with vastus lateralis muscle, and then structural reconstruction is performed with a titanium mesh. Finally, the titanium mesh is totally covered with the adiposal flap of the anterolateral thigh free flap. The muscle flap protects the dead space from infection, and the adiposal flap covers the titanium mesh to reduce mechanical stress on the covered skin and thus prevent the exposure of the titanium mesh through the scalp. By applying this technique, there was no intracranial infection or titanium mesh exposure in these 3 cases postoperatively, even though 2 patients had postoperative radiotherapy. Additionally, the adiposal flap could provide a soft and natural contour to the scalp and forehead region, and this gives patients a better facial appearance even though they have had skull base surgery. PMID:25954846

  13. A tomographic study of the skull base in primary spontaneous cerebrospinal fluid leaks

    Energy Technology Data Exchange (ETDEWEB)

    Giannetti, Alexandre Varella [Hospital das Clinicas, Service of Neurosurgery, Belo Horizonte (Brazil); Federal University of Minas Gerais, Department of Surgery, School of Medicine, Belo Horizonte (Brazil); Guimaraes, Roberto Eustaquio S. [Hospital das Clinicas, Services Otorhinolaryngology, Belo Horizonte (Brazil); Federal University of Minas Gerais, Department of Ophthalmology and Otorhinolaryngology, School of Medicine, Belo Horizonte (Brazil); Santiago, Ana Paula M.S. [Hospital das Clinicas, Services Radiology, Belo Horizonte (Brazil); Perpetuo, Francisco Otaviano L.; Machado, Marco Antonio O. [Computed Tomography Center of Minas Gerais, Belo Horizonte (Brazil)

    2012-05-15

    This study aims to evaluate the existence of anatomic abnormalities in the skull base that could contribute to the origin of primary spontaneous cerebrospinal fluid leaks (PSL). Twenty PSL patients were compared with 20 healthy individuals. The following features were measured through an analysis of computed tomography scans: the angles of the petrosal bones and skull base in both the sagittal and coronal planes; the anteroposterior and mediolateral diameters of the anterior skull base, sella, and sphenoid sinus; the depth of the olfactory fossa; the pneumatization of the sphenoid sinus; the position of the crista galli; and the state of the dorsum sellae. Body mass index (BMI) was compared. There were no differences between the two groups with respect to the angles and diameters of the anterior cranial fossa and the sphenoid sinus or the depth of the olfactory fossa. Pneumatization of the lateral recess of the sphenoid sinus was more frequent in the PSL group (55%) than in the control group (25%, p = 0.053). The dorsum sellae were eroded in 30% of the PSL patients but intact in all healthy subjects. PSL subjects showed higher sellae (1.0 versus 0.8 cm, p = 0.002). The average BMI of PSL patients was higher than that of the control group. Global alterations in the skull base of PSL patients were not found. The increase in the height of sellae and the erosion of its dorsum suggest intracranial hypertension. The higher BMI in the case group confirms the relation between obesity and PSL. (orig.)

  14. A Quantitative Analysis of Published Skull Base Endoscopy Literature.

    Science.gov (United States)

    Hardesty, Douglas A; Ponce, Francisco A; Little, Andrew S; Nakaji, Peter

    2016-02-01

    Objectives Skull base endoscopy allows for minimal access approaches to the sinonasal contents and cranial base. Advances in endoscopic technique and applications have been published rapidly in recent decades. Setting We utilized an Internet-based scholarly database (Web of Science, Thomson Reuters) to query broad-based phrases regarding skull base endoscopy literature. Participants All skull base endoscopy publications. Main Outcome Measures Standard bibliometrics outcomes. Results We identified 4,082 relevant skull base endoscopy English-language articles published between 1973 and 2014. The 50 top-cited publications (n = 51, due to articles with equal citation counts) ranged in citation count from 397 to 88. Most of the articles were clinical case series or technique descriptions. Most (96% [49/51])were published in journals specific to either neurosurgery or otolaryngology. Conclusions A relatively small number of institutions and individuals have published a large amount of the literature. Most of the publications consisted of case series and technical advances, with a lack of randomized trials. PMID:26949585

  15. Use of sodium fluorescein in skull base tumors

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo da Silva

    2010-10-01

    Full Text Available Objective: The authors present this study using sodium fluorescein (SF to enhance skull base tumors by performing a quantitative digital analysis of tumor enhancement. The purpose of this study is to observe the grade of SF enhancement by the tumors.Methods: A prospective experiment within-subjects study design was performed which included six patients with skull base lesions. Digital pictures were taken before and after the SF systemic injection, using the same light source of the microsurgical field. The pictures were analyzed by computer software which calculated the wavelength (WL of the SF pre- and post-injection.Results: The group of tumors was as follows: one vestibular schwannoma, three meningiomas, one craniopharyngioma and one pituitary adenoma. The SF enhancement in all tumors was strongly positive. The digital analysis of the pictures, considering the SF WL pre- and post-injection, presented P = 0.028 (Wilcoxon T test.Conclusions: The enhancement of the tumors by SF was consistent and evident. The introductory results suggest the possibility of using SF as an adjuvant tool for the skull base surgery. Further studies should test the clinical application of the SF in skull base tumors.

  16. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... opinion and was referred to our skull-base team. The next slide describes what we're doing ... exposure for our patients or the O.R. team. So we've fast-forwarded here a bit, ...

  17. Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty

    Directory of Open Access Journals (Sweden)

    Ferekidou Eliza

    2008-10-01

    Full Text Available Abstract Background Osteomas of ethmoid sinus are rare, especially when they involve anterior skull base and orbit, and lead to ophthalmologic and neurological symptoms. Case presentation The present case describes a giant ethmoid osteoma. Patient symptoms and signs were exophthalmos and proptosis of the left eye, with progressive visual acuity impairment and visual fields defects. CT/MRI scanning demonstrated a huge osseous lesion of the left ethmoid sinus (6.5 cm × 5 cm × 2.2 cm, extending laterally in to the orbit and cranially up to the anterior skull base. Bilateral extensive polyposis was also found. Endoscopic and external techniques were combined to remove the lesion. Bilateral endoscopic polypectomy, anterior and posterior ethmoidectomy and middle meatus antrostomy were performed. Finally, the remaining part of the tumor was reached and dissected from the surrounding tissue via a minimally invasive Lynch incision around the left middle canthus. During surgery, CSF rhinorrhea was observed and leakage was grafted with fascia lata and coated with bio-glu. Postoperatively, symptoms disappeared. Eighteen months after surgery, the patient is still free of symptoms. Conclusion Before management of ethmoid osteomas with intraorbital and skull base extension, a thorough neurological, ophthalmological and imaging evaluation is required, in order to define the bounders of the tumor, carefully survey the severity of symptoms and signs, and precisely plan the optimal treatment. The endoscopic procedure can constitute an important part of surgery undertaken for giant ethmoidal osteomas. In addition, surgeons always have to take into account a possible CSF leak and they have to be prepared to resolve it.

  18. Influence of the lateral ventricles and irregular skull base on brain kinematics due to sagittal plane head rotation.

    Science.gov (United States)

    Ivarsson, J; Viano, D C; Lövsund, P

    2002-08-01

    Two-dimensional physical models of the human head were used to investigate how the lateral ventricles and irregular skull base influence kinematics in the medial brain during sagittal angular head dynamics. Silicone gel simulated the brain and was separatedfrom the surrounding skull vessel by paraffin that provided a slip interface between the gel and vessel. A humanlike skull base model (HSB) included a surrogate skull base mimicking the irregular geometry of the human. An HSBV model added an elliptical inclusion filled with liquid paraffin simulating the lateral ventricles to the HSB model. A simplified skull base model (SSBV) included ventricle substitute but approximated the anterior and middle cranial fossae by a flat and slightly angled surface. The models were exposed to 7600 rad/s2 peak angular acceleration with 6 ms pulse duration and 5 deg forced rotation. After 90 deg free rotation, the models were decelerated during 30 ms. Rigid body displacement, shear strain and principal strains were determined from high-speed video recorded trajectories of grid markers in the surrogate brains. Peak values of inferior brain surface displacement and strains were up to 10.9X (times) and 3.3X higher in SSBV than in HSBV. Peak strain was up to 2.7X higher in HSB than in HSBV. The results indicate that the irregular skull base protects nerves and vessels passing through the cranial floor by reducing brain displacement and that the intraventricular cerebrospinal fluid relieves strain in regions inferior and superior to the ventricles. The ventricles and irregular skull base are necessary in modeling head impact and understanding brain injury mechanisms. PMID:12188208

  19. Proton therapy for tumors of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Munzenrider, J.E.; Liebsch, N.J. [Dept. of Radiation Oncology, Harvard Univ. Medical School, Boston, MA (United States)

    1999-06-01

    Charged particle beams are ideal for treating skull base and cervical spine tumors: dose can be focused in the target, while achieving significant sparing of the brain, brain stem, cervical cord, and optic nerves and chiasm. For skull base tumors, 10-year local control rates with combined proton-photon therapy are highest for chondrosarcomas, intermediate for male chordomas, and lowest for female chordomas (94%, 65%, and 42%, respectively). For cervical spine tumors, 10-year local control rates are not significantly different for chordomas and chondrosarcomas (54% and 48%, respectively), nor is there any difference in local control between males and females. Observed treatment-related morbidity has been judged acceptable, in view of the major morbidity and mortality which accompany uncontrolled tumor growth. (orig.)

  20. Atypical radiographic features of skull base cholesterol granuloma.

    Science.gov (United States)

    Dinh, Christine T; Goncalves, Stefania; Bhatia, Rita; Truong, Kim; Telischi, Fred; Angeli, Simon; Morcos, Jacques; Eshraghi, Adrien A

    2016-06-01

    Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG. PMID:26164292

  1. Intraoperative Monitoring of Motor Cranial Nerves in Skull Base Surgery

    OpenAIRE

    Maurer, Jan; Pelster, H.; Amedee, Ronald G.; Mann, Wolf J.

    1995-01-01

    Intraoperative monitoring of cranial nerves is performed to minimize postoperative cranial nerve dysfunction. We performed electrophysiologic monitoring of motor cranial nerves with a NIM 2 unit from Xomed Treace and a patient multiplexer developed in our clinic. This multiplexer allows simultaneous monitoring of four cranial nerves and is additionally equipped with a bipolar stimulation mode. This intraoperative monitoring was used during 102 skull base operations. Of these, 44 operations we...

  2. Surgeon's view of the skull base from the lateral approach.

    Science.gov (United States)

    Goldenberg, R A

    1984-12-01

    This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed. PMID:6503585

  3. Clinical results of proton beam therapy for skull base chordoma

    International Nuclear Information System (INIS)

    Purpose: To evaluate clinical results of proton beam therapy for patients with skull base chordoma. Methods and materials: Thirteen patients with skull base chordoma who were treated with proton beams with or without X-rays at the University of Tsukuba between 1989 and 2000 were retrospectively reviewed. A median total tumor dose of 72.0 Gy (range, 63.0-95.0 Gy) was delivered. The patients were followed for a median period of 69.3 months (range, 14.6-123.4 months). Results: The 5-year local control rate was 46.0%. Cause-specific, overall, and disease-free survival rates at 5 years were 72.2%, 66.7%, and 42.2%, respectively. The local control rate was higher, without statistical significance, for those with preoperative tumors <30 mL. Partial or subtotal tumor removal did not yield better local control rates than for patients who underwent biopsy only as the latest surgery. Conclusion: Proton beam therapy is effective for patients with skull base chordoma, especially for those with small tumors. For a patient with a tumor of <30 mL with no prior treatment, biopsy without tumor removal seems to be appropriate before proton beam therapy

  4. Skull Base Osteomyelitis in the Emergency Department: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Sayhan

    2011-01-01

    Full Text Available Skull base osteomyelitis (SBO is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

  5. Operative management of skull base malignant tumors arising from the nasal cavity and paranasal sinus. Recent strategies used in 25 cases

    International Nuclear Information System (INIS)

    Cancers of the paranasal sinuses and nasal cavity are the most common malignant tumors of the anterior and anterolateral skull base. The treatment of these tumors affecting the skull base is complex due to the significant anatomical features. We examined 25 patients, 17 males and 8 females with mean age 61±2 years. En bloc resections using anterior skull base resection, orbital resection, middle fossa resection, and combined procedures of these three resections were performed. Using a combination of adjuvant radiation and chemotherapy, we have achieved a 2-year disease-free survival rate of 90% in these cases. However, potential complications include cerebrospinal fluid leakage, meningitis, abscess formation, pneumocephalus, frontal brain contusion, trismus, and dysphagia as a functional complication. We believe that the optimal management of such malignant tumors involves a multimodal and multidisciplinary team approach. Here we present our recent institutional experience and treatment policy employed during the past 3 years. (author)

  6. Endovascular treatment for arterial injuries of skull base

    International Nuclear Information System (INIS)

    Objective: To explore the role of endovascular techniques in treatment for arterial injuries of skull base. Methods: A total of 53 consecutive cases suffered from skull base arterial injuries were enrolled in our hospital from Oct 2004 to May 2007, including 44 male and 9 female cases with average age of 23.3 years. Thirty-nine cases presented with pulsatile exophthalmos and intracranial vascular murmur, cerchnus and dysphagia in another 9, epistaxis in the remaining 5 cases. Diagnosis of 39 carotid cavernous fistulae (CCF)and 14 carotid pseudoaneurysm were performed by angiography (DSA). Alternative endovascular procedures were performed depending on lesions characteristics and follow-up was done by telephone and outpatient work up. Results: Procedures were performed involving 56 carotid arteries in all 53 cases including 34 CCF with embolization of detachable balloon(33 cases), 3 with balloon and coils, and 3 by stent-graft placement. 8 carotid pseudoaneurysms were cured by parent artery occlusion with balloon, 2 experienced endovascular isolation with balloon and coils, and 4 with stent-graft. Follow-up for mean 9.5 months (range from 2 to 25 months) revealed that the chief symptoms of 45 cases (85%) were relieved within 6 months after the procedure but ocular movement and visual disorder remained in 8 cases (15%)till 12 months. Six pseudoaneurysms and 3 residual leak were found in reexamination, of which 2 cases underwent intervention again 2 and 3 months later due to dural arterial-venous fistula in cavernous sinus, respectively. Conclusions: Endovascular treatment is safe and effective therapeutic option with minimal invasion for skull base arterial injuries. Detachable balloon embolization is the first choice for CCF and carotid pseudoaneurysm. Spring coil packing and stent-graft implantation should be in alternation as combination for special cases. (authors)

  7. Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas

    International Nuclear Information System (INIS)

    to assess the safety and efficacy of fractionated stereotactic radiotherapy (FSRT) for large skull base meningiomas. Fifty-two patients with large skull base meningiomas aged 34-74 years (median age 56 years) were treated with FSRT between June 2004 and August 2009. All patients received FSRT for residual or progressive meningiomas more than 4 centimeters in greatest dimension. The median GTV was 35.4 cm3 (range 24.1-94.9 cm3), and the median PTV was 47.6 cm3 (range 33.5-142.7 cm3). Treatment volumes were achieved with 5-8 noncoplanar beams shaped using a micromultileaf collimator (MLC). Treatment was delivered in 30 daily fractions over 6 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively. At a median follow-up of 42 months (range 9-72 months) the 3-year and 5-year progression-free survival (PFS) rates were 96% and 93%, respectively, and survival was 100%. Three patients required further debulking surgery for progressive disease. Hypopituitarism was the most commonly reported late complication, with a new hormone pituitary deficit occurring in 10 (19%) of patients. Clinically significant late neurological toxicity was observed in 3 (5.5%) patients consisting of worsening of pre-existing cranial deficits. FSRT as a high-precision technique of localized RT is suitable for the treatment of large skull base meningiomas. The local control is comparable to that reported following conventional external beam RT. Longer follow-up is required to assess long term efficacy and toxicity, particularly in terms of potential reduction of treatment-related late toxicity

  8. Plasmacytoma of the Skull Base: A Meta-Analysis.

    Science.gov (United States)

    Na'ara, Shorook; Amit, Moran; Gil, Ziv; Billan, Salem

    2016-02-01

    Objective Extramedullary plasmacytomas are rare tumors. In the current study we aim to characterize its clinical course at the skull base and define the most appropriate therapeutic protocol. Methods We conducted a meta-analysis of articles in the English language that included data on the treatment and outcome of plasmacytoma of the base of skull. Results The study cohort consisted of 47 patients. The tumor originated from the clivus and sphenoclival region in 28 patients (59.5%), the nasopharynx in 10 patients (21.2%), the petrous apex in 5 patients (10.6%), and the orbital roof in 4 patients (8.5%). The chief complaints at presentation included recurrent epistaxis and cranial nerve palsy, according to the site of tumor. Twenty-two patients (46.8%) had surgical treatment; 25 (53.2%) received radiation therapy. Adjuvant therapy was administered in 11 cases (50%) with concurrent multiple myeloma. The 2-year and 5-year overall survival rates were 78% and 59%, respectively. Clear margin resection was achieved in a similar proportion of patients who underwent endoscopic surgery and open surgery (p = 0.83). A multivariate analysis of outcome showed a similar survival rate of patients treated surgically or with radiotherapy. Conclusions The mainstay of treatment for plasmacytoma is based on radiation therapy, but when total resection is feasible, endoscopic resection is a valid option. PMID:26949590

  9. Radiotherapy and radiosurgery for benign skull base meningiomas

    International Nuclear Information System (INIS)

    Meningiomas located in the region of the base of skull are difficult to access. Complex combined surgical approaches are more likely to achieve complete tumor removal, but frequently at a cost of treatment related high morbidity. Local control following subtotal excision of benign meningiomas can be improved with conventional fractionated external beam radiation therapy with a reported 5-year progression-free survival up to 95%. New radiation techniques, including stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), and intensity-modulated radiotherapy (IMRT) have been developed as a more accurate technique of irradiation with more precise tumor localization, and consequently a reduction in the volume of normal brain irradiated to high radiation doses. SRS achieves a high tumour control rate in the range of 85-97% at 5 years, although it should be recommended only for tumors less than 3 cm away more than 3 mm from the optic pathway because of high risk of long-term neurological deficits. Fractionated RT delivered as FSRT, IMRT and protons is useful for larger and irregularly or complex-shaped skull base meningiomas close to critical structures not suitable for single-fraction SRS. The reported results indicate a high tumour control rate in the range of 85-100% at 5 years with a low risk of significant incidence of long-term toxicity. Because of the long natural history of benign meningiomas, larger series and longer follow-up are necessary to compare results and toxicity of different techniques

  10. [Gross tumor volume (GTV) and clinical target volume (CTV) in radiotherapy of benign skull base tumors].

    Science.gov (United States)

    Maire, J P; Liguoro, D; San Galli, F

    2001-10-01

    Skull base tumours represent about 35 to 40% of all intracranial tumours. There are now many reports in the literature confirming the fact that about 80 to 90% of such tumours are controlled with fractionated radiotherapy. Stereotactic and 3-dimensional treatment planning techniques increase local control and central nervous system tolerance. Definition of the gross tumor volume (GTV) is generally easy with currently available medical imaging systems and computers for 3-dimensional dosimetry. The definition of the clinical target volume (CTV) is more difficult to appreciate; it is defined from the CTV plus a margin, which depends on the histology and anterior therapeutic history of the tumour. It is important to take into account the visible tumour and its possible extension pathways (adjacent bone, holes at the base of skull) and/or an anatomic region (sella turcica + adjacent cavernous sinus). It is necessary to evaluate these volumes with CT Scan and MRI to appreciate tumor extension in a 3-dimentional approach, in order to reduce the risk of marginal recurrences. The aim of this paper is to discuss volume definition as a function of tumour site and tumour type to be irradiated. PMID:11715310

  11. Papillary thyroid microcarcinoma presenting as skull base metastasis

    Institute of Scientific and Technical Information of China (English)

    YAN Bo; LIU Dian-gang; L(U) Hai-li; ZHANG Qiu-hang

    2010-01-01

    @@ Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid cancer and is considered to be a relatively indolent tumor in which distant metastasis and death are rare.1 The metastasis of PTC is usually to regional lymph nodes, especially the cervical and mediastinal nodes. Metastases to the brain are rare, and constitute 0.1%-5.0% of distant metastases of papillary carcinoma.2 Skull metastasis is uncommon,and is found in 2.5%-5.8% of cases of thyroid cancer.3 Skull base metastasis of PTC is extremely rare, with only eight reported cases in the literature involving the clivus,cavernous sinus, sella turcica, and the petrous apex and ridge.4 A metastatic lesion can arise from histologically benign and silent thyroid neoplasms,5 and differential diagnosis between ectopic and metastatic thyroid cancer can be difficult,6 therefore, the management of thyroid cancer is controversial after removal of metastatic disease.Here we reported a case of papillary thyroid microcarcinoma (PTMC) that was manifested as a solitary clivus metastasis and discussed the diagnostic and therapeutic management strategies. The 73-year-old patient presented with visual impairment in the right eye,and epistaxis. The patient subsequently underwent complete total thyroidectomy after a diagnosis of papillary microcarcinoma. This finding emphasizes that clinically significant metastases can arise from thyroid papillary microcarcinoma. Total thyroidectomy and careful review of the histology are necessary to prevent delay in proper diagnosis.

  12. The cranial base and calvaria index methods applied to Australian aborigine skulls.

    Science.gov (United States)

    Göthlin, J H; Gadeholt, G

    1988-11-01

    Cranial base and calvaria indices were calculated on lateral skull radiographs of Australian aborigines, and compared with the values of one mummy, 4 prehistoric (fossil), and modern Scandinavian skulls. The aborigines had thicker calvarian bone and a lower forehead profile than the mummy and the modern skulls, but a higher frontal calvarium than the fossils. The aborigines may developmentally represent a link between prehistoric and modern man (including the mummy). PMID:3234401

  13. Clinicopathological and Molecular Histochemical Review of Skull Base Metastasis from Differentiated Thyroid Carcinoma

    International Nuclear Information System (INIS)

    Skull base metastasis from differentiated thyroid carcinoma including follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) is a rare clinical entity. Eighteen FTC cases and 10 PTC cases showing skull base metastasis have been reported. The most common symptom of skull base metastasis from FTC and PTC is cranial nerve dysfunction. Bone destruction and local invasion to the surrounding soft tissues are common on radiological imaging. Skull base metastases can be the initial clinical presentation of FTC and PTC in the presence of silent primary sites. The possibility of skull base metastasis from FTC and PTC should be considered in patients with the clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction. A variety of genetic alterations in thyroid tumors have been identified to have a fundamental role in their tumorigenesis. Molecular histochemical studies are useful for elucidating the histopathological features of thyroid carcinoma. Recent molecular findings may provide novel molecular-based treatment strategies for thyroid carcinoma

  14. Skull base chordomas: analysis of dose-response characteristics

    International Nuclear Information System (INIS)

    Objective: To extract dose-response characteristics from dose-volume histograms and corresponding actuarial survival statistics for 115 patients with skull base chordomas. Materials and Methods: We analyzed data for 115 patients with skull base chordoma treated with combined photon and proton conformal radiotherapy to doses in the range 66.6Gy - 79.2Gy. Data set for each patient included gender, histology, age, tumor volume, prescribed dose, overall treatment time, time to recurrence or time to last observation, target dose-volume histogram, and several dosimetric parameters (minimum/mean/median/maximum target dose, percent of the target volume receiving the prescribed dose, dose to 90% of the target volume, and the Equivalent Uniform Dose (EUD). Data were analyzed using the Kaplan-Meier survivor function estimate, the proportional hazards (Cox) model, and parametric modeling of the actuarial probability of recurrence. Parameters of dose-response characteristics were obtained using the maximum likelihood method. Results: Local failure developed in 42 (36%) of patients, with actuarial local control rates at 5 years of 59.2%. The proportional hazards model revealed significant dependence of gender on the probability of recurrence, with female patients having significantly poorer prognosis (hazard ratio of 2.3 with the p value of 0.008). The Wilcoxon and the log-rank tests of the corresponding Kaplan-Meier recurrence-free survival curves confirmed statistical significance of this effect. The Cox model with stratification by gender showed significance of tumor volume (p=0.01), the minimum target dose (p=0.02), and the EUD (p=0.02). Other parameters were not significant at the α level of significance of 0.05, including the prescribed dose (p=0.21). Parametric analysis using a combined model of tumor control probability (to account for non-uniformity of target dose distribution) and the Weibull failure time model (to account for censoring) allowed us to estimate

  15. Use of a Galeopericranial Flap for the Reconstruction of Anterior Cranial Base Defects

    OpenAIRE

    Chia-Hsiang Fu; Sheng-Po Hao; Yung-Shin Hsu

    2005-01-01

    Background: To evaluate the efficacy of using a galeopericranial flap for reconstruction ofanterior cranial base defects.Methods: In Linkou Chang Gung Memorial Hospital from February 1994 to November2003, 25 patients who had tumors of the skull base underwent craniofacialresection, and a galeopericranial flap was used to reconstruct the anterior cranialbase defect. The galeopericranial flap was developed and based on atleast 1 side of the supraorbital or supratrochlear arteries and veins; it ...

  16. The cranial base of Australopithecus afarensis: new insights from the female skull.

    Science.gov (United States)

    Kimbel, William H; Rak, Yoel

    2010-10-27

    Cranial base morphology differs among hominoids in ways that are usually attributed to some combination of an enlarged brain, retracted face and upright locomotion in humans. The human foramen magnum is anteriorly inclined and, with the occipital condyles, is forwardly located on a broad, short and flexed basicranium; the petrous elements are coronally rotated; the glenoid region is topographically complex; the nuchal lines are low; and the nuchal plane is horizontal. Australopithecus afarensis (3.7-3.0 Ma) is the earliest known species of the australopith grade in which the adult cranial base can be assessed comprehensively. This region of the adult skull was known from fragments in the 1970s, but renewed fieldwork beginning in the 1990s at the Hadar site, Ethiopia (3.4-3.0 Ma), recovered two nearly complete crania and major portions of a third, each associated with a mandible. These new specimens confirm that in small-brained, bipedal Australopithecus the foramen magnum and occipital condyles were anteriorly sited, as in humans, but without the foramen's forward inclination. In the large male A.L. 444-2 this is associated with a short basal axis, a bilateral expansion of the base, and an inferiorly rotated, flexed occipital squama--all derived characters shared by later australopiths and humans. However, in A.L. 822-1 (a female) a more primitive morphology is present: although the foramen and condyles reside anteriorly on a short base, the nuchal lines are very high, the nuchal plane is very steep, and the base is as relatively narrow centrally. A.L. 822-1 illuminates fragmentary specimens in the 1970s Hadar collection that hint at aspects of this primitive suite, suggesting that it is a common pattern in the A. afarensis hypodigm. We explore the implications of these specimens for sexual dimorphism and evolutionary scenarios of functional integration in the hominin cranial base. PMID:20855310

  17. Quality of life following endonasal skull base surgery.

    Science.gov (United States)

    Pant, Harshita; Bhatki, Amol M; Snyderman, Carl H; Vescan, Allan D; Carrau, Ricardo L; Gardner, Paul; Prevedello, Daniel; Kassam, Amin B

    2010-01-01

    The importance of quality of life (QOL) outcomes following treatments for head and neck tumors are now increasingly appreciated and measured to improve medical and surgical care for these patients. An understanding of the definitions in the setting of health care and the use of appropriate QOL instruments and measures are critical to obtain meaningful information that guides decision making in various aspects of patient health care. QOL outcomes following cranial base surgery is only recently being defined. In this article, we describe the current published data on QOL outcomes following cranial base surgery and provide preliminary prospective data on QOL outcomes and sinonasal morbidity in patients who underwent endonasal cranial base surgery for management of various skull base tumors at our institution. We used a disease-specific multidimensional instrument to measure QOL outcomes in these patients. Our results show that although sinonasal morbidity is increased, this is temporary, and the vast majority of patients have a very good QOL by 4 to 6 months after endonasal approach to the cranial base. PMID:20592856

  18. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... face or skull. The minimally invasive technique allows patients a quicker recovery with less blood loss than ... the slides here, we'll talk about our patient history for a few moments. Our patient today ...

  19. CT and MRI of the skull base, including the cranial nerves

    International Nuclear Information System (INIS)

    Some considerations about nuclear magnetic resonance and computerized tomography, essential for examining skull base lesions are treated here, including the cranial nerves. Neoplasms such as meningiomas, adenomas, chordomas, chondrosarcomas and others tumors are also cited, mentioning some commentaries. (author)

  20. Transmastoid Repair of Minor Skull Base Defects with Flexible Hydroxyapatite Sheets

    OpenAIRE

    Zanetti, Diego; Nassif, Nader

    2003-01-01

    This prospective open pilot study was designed to assess the suitability of flexible composite sheets of polymer and hydroxyapatite (HA) for the reconstruction of limited lateral skull base defects through a conservative transmastoid approach.

  1. Juvenile nasopharyngeal angiofibroma with skull base invasion : intratumoral direct puncture embolization

    International Nuclear Information System (INIS)

    The purpose of this study is to demonstrate the utility and efficacy of percutaneous direct glue embolization for juvenile nasopharyngeal angiofibromas with skull base invasion. In nine cases of juvenile nasopharyngeal angiofibromas with invasion of the skull base, embolization under general anethesia was performed. Using an 18G spinal needle, direct puncture were made via the transnasal or mandibular sciatic notch. A glue-lipiodol mixture (1:1 -1:3) was injected slowly for 15 to 30 seconds under fluoroscopic control; the number of post-embolization angiography and the distribution of embolic materials was assessed on CT within 1-3 days. The mass was surgically removed 3 to 7 days after embolization. Direct glue embolization of juvenile angiofibroma with skull base invasion appears to be a simple and safe procedure. The technique could be used for other hypervascular lesions in the base of the skull or parapharyngeal space. (author). 19 refs., 1 tab., 2 figs

  2. Volumetric-modulated arc radiotherapy for skull-base and non-skull-base head and neck cancer: a treatment planning comparison with fixed Beam IMRT.

    Science.gov (United States)

    Chen, J; Mok, E; Wang, L; Chen, C; Le, Q-T

    2013-02-01

    The purpose of this study is to compare the dose distribution, monitor units (MUs) and radiation delivery time between volumetric-modulated arc (VMAT) and fix-beam intensity modulated radiotherapy (FB-IMRT) in skull-base and non-skull-base head and neck cancer (HNC). CT datasets of 8 skull-base and 7 non-skull-base HNC were identified. IMRT and VMAT plans were generated. The prescription dose ranged 45-70 Gy (1.8-2.2 Gy/fraction). The VMAT delivery time was measured when these plans were delivered to the patients. The FB-IMRT delivery time was generated on a phantom. Comparison of dose-volume histogram data, MUs, and delivery times was performed using T-test. Our results show that both plans yield similar target volume coverage, homogeneity, and conformity. In skull-base cases, compared to FB-IMRT, VMAT generated significantly smaller hot-spot inside PTV (2.0% vs. 4.5%, p = 0.031), lower maximum chiasm dose (32 ± 11 Gy vs. 41 ± 15 Gy, p = 0.026), lower ipsilateral temporal-mandibular joint dose (D33: 41.4 Gy vs. 46.1 Gy, p = 0.016), lower mean ipsilateral middle ear dose (43 ± 9 Gy vs. 38 ± 10 Gy, p = 0.020) and a trend for lower optic nerve, temporal lobe, parotid, and oral cavity dose. In non-skull-base cases, doses to normal tissues were similar between the two plans. There was a reduction of 70% in MUs (486 ± 95 vs. 1614 ± 493, p VMAT. We conclude that VMAT appears to spare more normal tissues from high radiation dose for the tested skull-base tumors. Dosimetrically, both approaches were equivalent for non-skull-base tumor with VMAT using fewer MUs and shorter delivery time. PMID:22905805

  3. Particle Beam Therapy for Cancer of the Skull Base, Nasal Cavity, and Paranasal Sinus

    OpenAIRE

    Fukumitsu, Nobuyoshi

    2012-01-01

    Particle beam therapy has been rapidly developed in these several decades. Proton and carbon ion beams are most frequently used in particle beam therapy. Proton and carbon ion beam radiotherapy have physical and biological advantage to the conventional photon radiotherapy. Cancers of the skull base, nasal cavity, and paranasal sinus are rare; however these diseases can receive the benefits of particle beam radiotherapy. This paper describes the clinical review of the cancer of the skull base,...

  4. Proton radiotherapy in management of pediatric base of skull tumors

    International Nuclear Information System (INIS)

    Purpose: Primary skull base tumors of the developing child are rare and present a formidable challenge to both surgeons and radiation oncologists. Gross total resection with negative margins is rarely achieved, and the risks of functional, structural, and cosmetic deficits limit the radiation dose using conventional radiation techniques. Twenty-nine children and adolescents treated with conformal proton radiotherapy (proton RT) were analyzed to assess treatment efficacy and safety. Methods and Materials: Between July 1992 and April 1999, 29 patients with mesenchymal tumors underwent fractionated proton (13 patients) or fractionated combined proton and photon (16 patients) irradiation. The age at treatment ranged from 1 to 19 years (median 12); 14 patients were male and 15 female. Tumors were grouped as malignant or benign. Twenty patients had malignant histologic findings, including chordoma (n=10), chondrosarcoma (n=3), rhabdomyosarcoma (n=4), and other sarcomas (n=3). Target doses ranged between 50.4 and 78.6 Gy/cobalt Gray equivalent (CGE), delivered at doses of 1.8-2.0 Gy/CGE per fraction. The benign histologic findings included giant cell tumors (n=6), angiofibromas (n=2), and chondroblastoma (n=1). RT doses for this group ranged from 45.0 to 71.8 Gy/CGE. Despite maximal surgical resection, 28 (97%) of 29 patients had gross disease at the time of proton RT. Follow-up after proton RT ranged from 13 to 92 months (mean 40). Results: Of the 20 patients with malignant tumors, 5 (25%) had local failure; 1 patient had failure in the surgical access route and 3 patients developed distant metastases. Seven patients had died of progressive disease at the time of analysis. Local tumor control was maintained in 6 (60%) of 10 patients with chordoma, 3 (100%) of 3 with chondrosarcoma, 4 (100%) of 4 with rhabdomyosarcoma, and 2 (66%) of 3 with other sarcomas. The actuarial 5-year local control and overall survival rate was 72% and 56%, respectively, and the overall survival

  5. Alignment of CT images of skull dysmorphology using anatomy-based perpendicular axes

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Sun K [Department of Medical Engineering, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong O [Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Institute of Human Tissue Restoration, Seoul (Korea, Republic of); Kim, Hee-Joung [Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Nam H [Department of Medical Engineering, Yonsei University College of Medicine, Seoul (Korea, Republic of); Jang, Young Beom [Department of Information and Telecommunication Engineering, Sangmyung University, Cheoan (Korea, Republic of); Kim, Kee-Deog [Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul (Korea, Republic of); Lee, Hye-Yeon [Department of Anatomy, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2003-08-21

    Rigid body registration of 3D CT scans, based on manual identification of homologous landmarks, is useful for the visual analysis of skull dysmorphology. In this paper, a robust and simple alignment method was proposed to allow for the comparison of skull morphologies, within and between individuals with craniofacial anomalies, based on 3D CT scans, and the minimum number of anatomical landmarks, under rigidity and uniqueness constraints. Three perpendicular axes, extracted from anatomical landmarks, define the absolute coordinate system, through a rigid body transformation, to align multiple CT images for different patients and acquisition times. The accuracy of the alignment method depends on the accuracy of the localized landmarks and target points. The numerical simulation generalizes the accuracy requirements of the alignment method. Experiments using a human dried skull specimen, and ten sets of skull CT images (the pre- and post-operative CT scans of four plagiocephaly, and one fibrous dysplasia patients), demonstrated the feasibility of the technique in clinical practice.

  6. Alignment of CT images of skull dysmorphology using anatomy-based perpendicular axes

    International Nuclear Information System (INIS)

    Rigid body registration of 3D CT scans, based on manual identification of homologous landmarks, is useful for the visual analysis of skull dysmorphology. In this paper, a robust and simple alignment method was proposed to allow for the comparison of skull morphologies, within and between individuals with craniofacial anomalies, based on 3D CT scans, and the minimum number of anatomical landmarks, under rigidity and uniqueness constraints. Three perpendicular axes, extracted from anatomical landmarks, define the absolute coordinate system, through a rigid body transformation, to align multiple CT images for different patients and acquisition times. The accuracy of the alignment method depends on the accuracy of the localized landmarks and target points. The numerical simulation generalizes the accuracy requirements of the alignment method. Experiments using a human dried skull specimen, and ten sets of skull CT images (the pre- and post-operative CT scans of four plagiocephaly, and one fibrous dysplasia patients), demonstrated the feasibility of the technique in clinical practice

  7. First nimravid skull from Asia

    OpenAIRE

    Averianov, Alexander; Obraztsova, Ekaterina; Danilov, Igor; Skutschas, Pavel; Jin, Jianhua

    2016-01-01

    Maofelis cantonensis gen. and sp. nov. is described based on a complete cranium from the middle-upper Eocene Youganwo Formation of Maoming Basin, Guangdong Province, China. The new taxon has characters diagnostic for Nimravidae such as a short cat-like skull, short palate, ventral surface of petrosal dorsal to that of basioccipital, serrations on the distal carina of canine, reduced anterior premolars, and absence of posterior molars (M2-3). It is plesiomorphic nimravid taxon similar to Nimra...

  8. Perioperative management of complex skull base surgery: the anesthesiologist's point of view.

    Science.gov (United States)

    Jellish, W Scott; Murdoch, John; Leonetti, John P

    2002-05-15

    The anesthetic management of complex skull base surgical procedures provides unique problems and concerns for the neuroanesthesiologist. Positioning to access the skull base could put the patient at risk for peripheral nerve injury and some of the positions may increase the risk for air emboli. In addition, tumor pathology and involvement with vital structures could increase the chances for substantive blood loss, destruction of associated nerves or vessels, and may require temporary occlusion of the carotid artery necessitating intraoperative neuroprotection. Neurophysiological monitors may also be used to safeguard nerve function and anesthetic techniques must be adjusted to accommodate their use. Finally, postoperative morbidity may be affected by surgical approach to the skull base and the anesthesiologist should be aware of which approach may produce a greater incidence of pain, nausea, and vomiting in the postoperative period. The authors discuss the anesthetic concerns and management for complex cranial base surgery. Different approaches will be discussed and comparisons of perioperative parameters between these approaches will be made with data provided by retrospective chart review of more than 600 skull base procedures performed at the authors' institution over the last 10 years. This information should help guide decision making concerning anesthetic management for these skull base procedures. PMID:16119903

  9. Development of skull fracture criterion based on real-world head trauma simulations using finite element head model.

    Science.gov (United States)

    Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy

    2016-04-01

    The objective of this study was to enhance an existing finite element (FE) head model with composite modeling and a new constitutive law for the skull. The response of the state-of-the-art FE head model was validated in the time domain using data from 15 temporo-parietal impact experiments, conducted with postmortem human surrogates. The new model predicted skull fractures observed in these tests. Further, 70 well-documented head trauma cases were reconstructed. The 15 experiments and 70 real-world head trauma cases were combined to derive skull fracture injury risk curves. The skull internal energy was found to be the best candidate to predict skull failure based on an in depth statistical analysis of different mechanical parameters (force, skull internal energy), head kinematic-based parameter, the head injury criterion (HIC), and skull fracture correlate (SFC). The proposed tolerance limit for 50% risk of skull fracture was associated with 453mJ of internal energy. Statistical analyses were extended for individual impact locations (frontal, occipital and temporo-parietal) and separate injury risk curves were obtained. The 50% risk of skull fracture for each location: frontal: 481mJ, occipital: 457mJ, temporo-parietal: 456mJ of skull internal energy. PMID:26703363

  10. 3-D-CT reconstructions in fractures of the skull base and facial skeleton

    International Nuclear Information System (INIS)

    3-D reconstructions of the skull base, temporal bone, and skull fractures were compared to 2-D CT to evaluate the diagnostic value in traumatized patients. 38 patients with 22 fractures of the facial skeleton (orbita, zygomatic, Le Fort), 12 temporal bone, and 4 skull fractures were investigated. Subjective grading was perfomed by two physicians (ENT/RAD) in respect of quality diagnostic validity and estimated clinical impact. The average image validity and quality were graded good. In the temporal bone the average information supplied by 3-D was of inferior value; here, the lack of information regarding the inner ear structures was responsible for the lack of clinical impact. In fractures of the facial skeleton and the skull base of good to very good image quality was seen and clinical relevance was high. 3-D CT is capable of demonstrating fractures, which is of little value in the temporal bone, but of high value in the skull base and the facial skeleton, especially if surfaces are involved or fragments are displaced. (orig.)

  11. Eosinophilic granuloma of the skull base: patient with unique clinical moreover, radiographic presentation.

    Directory of Open Access Journals (Sweden)

    Hosein Dalili

    2015-01-01

    Full Text Available This case report presents an eight-year-old girl having periauricular swelling and severe pain during mouth opening on the right-side temporomandibular joint (TMJ. CBCT showed extensive destruction of the base of the skull and the roof of the glenoid fossa on the right side. The findings based on CT and MRI images with and without contrast are discussed herein. This report highlights a skull base eosinophilic granuloma that mimics TMJ disorder and the importance of proper evaluation of CBCT images to make an early diagnosis.

  12. Anatomy of the skull base and the cranial nerves in slice imaging

    International Nuclear Information System (INIS)

    Computed tomography (CT) and magnetic resonance imaging (MRI) are suitable methods for examination of the skull base. Whereas CT is used to evaluate mainly bone destruction e.g. for planning surgical therapy, MRI is used to show pathologies in the soft tissue and bone invasion. High resolution and thin slice thickness are indispensible for both modalities of skull base imaging. Detailed anatomical knowledge is necessary even for correct planning of the examination procedures. This knowledge is a requirement to be able to recognize and interpret pathologies. MRI is the method of choice for examining the cranial nerves. The total path of a cranial nerve can be visualized by choosing different sequences taking into account the tissue surrounding this cranial nerve. This article summarizes examination methods of the skull base in CT and MRI, gives a detailed description of the anatomy and illustrates it with image examples. (orig.)

  13. Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

    Directory of Open Access Journals (Sweden)

    Harminder Singh

    2016-01-01

    Full Text Available Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

  14. Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

    Directory of Open Access Journals (Sweden)

    Kundan Mittal

    2015-10-01

    Full Text Available Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

  15. Fibromyxoma of the Lateral Skull Base in a Child: Case Report

    OpenAIRE

    Klimo, Paul; Jha, Tushar; Choudhri, Asim F.; Joyner, Royce; Michael, L. Madison

    2013-01-01

    Purpose Fibromyxomas and myxomas are benign tumors of mesenchymal origin usually found outside the nervous system, most commonly in the atrium of the heart. They can also arise in the mandible or maxilla, but it is exceedingly rare to find them within the skull base. The history, histologic features, and the literature, with emphasis on other pediatric cases, are reviewed for this uncommon skull base neoplasm. Methods We describe the case of a 13-year-old girl who presented with a 1-year hist...

  16. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... re able to see the normal tumor or cancer interface. And so here we're actually working in the cavernous sinus right here. And we're working off on ... where the tumor is at or where the cancer is at. 00:48:08 RAN VIJAI ... of the anterior intercavernous sinus. And it is right here in this area ...

  17. Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Komune, Noritaka; Archer, Jacob B; Sun, Hai; Theodore, Nicholas; James, Jeffrey; Little, Andrew S; Nakaji, Peter; Sughrue, Michael E; Rhoton, Albert L; Spetzler, Robert F

    2016-08-01

    OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes. PMID:26613175

  18. Skull Base Meningiomas and Cranial Nerves Contrast Using Sodium Fluorescein: A New Application of an Old Tool

    OpenAIRE

    da Silva, Carlos Eduardo; da Silva, Vinicius Duval; da Silva, Jefferson Luis Braga

    2014-01-01

    Objective The identification of cranial nerves is one of the most challenging goals in the dissection of skull base meningiomas. The authors present an application of sodium fluorescein (SF) in skull base meningiomas with the purpose of improving the identification of cranial nerves.

  19. Cranial nerve palsies in metastatic prostate cancer--results of base of skull radiotherapy

    International Nuclear Information System (INIS)

    We studied the rate of response to palliative external beam radiation therapy (20 Gy/5 or 30 Gy/10 fractions) to the base of skull in 32 prostate cancer patients with cranial nerve dysfunction. Sixteen patients (50%; 95% CI, 34-66%) had a useful response to therapy. The median survival post-therapy was 3 months

  20. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    International Nuclear Information System (INIS)

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  1. Large and giant skull base meningiomas: The role of radical surgical removal

    Science.gov (United States)

    da Silva, Carlos Eduardo; de Freitas, Paulo Eduardo Peixoto

    2015-01-01

    Background: The large and giant skull base meningiomas are challenging lesions, and the involvement of crucial neurovascular structures needs the surgical removal as the primordial treatment. The authors report on a series of patients with large and giant skull base meningiomas who were treated with the goal of radical removal. Methods: A retrospective study including 49 patients with large and giant skull base meningiomas was carried out. Tumors presenting 3 cm or larger were included. Results: The meningiomas in the sample included the following types: 10 olfactory groove, 8 sphenoorbital, 8 petroclival, 8 tentorial, 4 clinoidal, 4 cavernous sinus, 3 temporal floor, 2 tuberculum sellae and 2 foramen magnum. The average age was 53 years, the mean follow-up period was 52 months, Simpson Grades I and II were obtained in 75.5%. The overall mortality was 5%. Transient cranial nerve deficits occurred in 32% with definite cranial nerve lesion in 18%. Cerebrospinal fluid leak occurred in 14%. Conclusions: The surgical treatment is a mandatory option for large and giant skull base meningiomas. The radical removal is achievable and should be considered an alternative with a good outcome and an acceptable morbidity for such challenge lesions. PMID:26167365

  2. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    Energy Technology Data Exchange (ETDEWEB)

    Droege, L.H.; Hinsche, T.; Hess, C.F.; Wolff, H.A. [University Hospital of Goettingen, Department of Radiotherapy and Radiation Oncology, Goettingen (Germany); Canis, M. [University of Goettingen, Department of Otorhinolaryngology, Head and Neck Surgery, Goettingen (Germany); Alt-Epping, B. [University of Goettingen, Department of Palliative Medicine, Goettingen (Germany)

    2014-02-15

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  3. Evaluation of Three Cases Using a Novel Titanium Mesh System-Skull-Fit with Orbital Wall (Skull-Fit WOW)-For Cranial Base Reconstructions.

    Science.gov (United States)

    Hattori, Noriko; Nakajima, Hideo; Tamada, Ikkei; Sakamoto, Yoshiaki; Ohira, Takayuki; Yoshida, Kazunari; Kawase, Takeshi; Kishi, Kazuo

    2011-09-01

    Cranial base reconstructions associated with tumor resections around the orbital wall often require that both the upper and lateral orbital walls be reconstructed during a single procedure. Previously, we used titanium mesh plates that were preoperatively fabricated based on three-dimensional models. Although these plates are precise and do not increase the probability of infection, we still had to use autologous bones to reconstruct the orbital walls. Recently, we developed a new titanium mesh plate-called Skull-Fit(®)-with orbital wall (Skull-Fit WOW(®)), enabling us to reconstruct the cranial base and orbital walls without bone grafts. Here, we report on three reconstruction cases in which the novel titanium mesh-orbital wall system was used. In all three cases, the customized titanium mesh system performed satisfactorily with little, if any, complications. PMID:22451827

  4. Extreme lateral transcondylar approach to the skull base.

    Directory of Open Access Journals (Sweden)

    Banerji D

    1999-01-01

    Full Text Available In this study, the authors present their experience of using extreme later transcondylar approach (ELTC for treating 7 patients with lesions in the anterolateral foramen magnum, upper cervical spine and cerebellopontine angle reaching upto jugular foramen. The tumours included meningiomas, neurofibromas (2 cases each, chondrosarcoma, epidermoid and aneurysmal bone cyst (one case each. The approach was used alone, in combination with retrolabyrinthine presigmoid approach in a patient with lower cranial nerve neurofibroma extending extracranially through the jugular foramen, or in combination with partial C1-C3 laminectomy in two patients with meningiomas situated anterolateral to the cord from the foramen magnum to C3. In two patients with extradural vertebral artery (VA entrapment by a chondrosarcoma and aneurysmal bone cyst respectively, the vertebral artery was ligated distal to the tumour. The tumours were totally excised in five cases and partially in two. There was no preoperative mortality. The major complications included cerebrospinal fluid leak from the wound (3 cases and increase in lower cranial nerve paresis (2 cases. At follow up, ranging from 6 months to 2 years, 5 patients showed no tumour recurrence. There was improvement in neurological status. One patient, with a partially excised aneurysmal bone cyst, showed no added deficits or increase in the tumour size. However, there was a massive regrowth in the patient with chondrosarcoma after 6 months. This technique provided a wide surgical exposure with direct visualization of the tumour-anterior cord interface, early proximal control of the VA and preservation of lower cranial nerves.

  5. Skull Base Allergic Fungal Sinusitis with Abducens Palsy in the Third Trimester

    OpenAIRE

    Rassekh, Christopher H.; Kinsella, John B.; Calhoun, Karen H.; Maggio, William W.; Chaljub, Gregory; Gourley, William K.

    1996-01-01

    Allergic fungal sinusitis (AFS) usually follows a slow course, but bone erosion including that of the skull base can be seen. Patients may present with intracranial extension mimicking a cranial base neoplasm. We describe a 21-year-old pregnant female initially seen at 27 weeks gestation with a complete right sixth nerve paralysis. MR imaging showed an apparent nasopharyngeal neoplasm invading both temporal lobes. Further evaluation revealed typical findings of fungal sinusitis on both CT and...

  6. Arrested pneumatization of the sphenoid sinus mimicking intraosseous lesions of the skull base

    International Nuclear Information System (INIS)

    Arrested pneumatization of the sphenoid sinus is a developmental variant that is not always well recognized and is often confused with other pathologies associated with the skull base. This report describes the case of a patient referred for cone-beam computed tomography (CBCT) imaging for dental implant therapy. CBCT demonstrated a well-defined incidental lesion in the left sphenoid sinus with soft tissue-like density and sclerotic borders with internal curvilinear opacifications. The differential diagnoses included intraosseous lipoma, arrested pneumatization of the sphenoid sinus, chondrosarcoma, chondroid chordoma, and ossifying fibroma. The radiographic diagnosis of arrested pneumatization was based on the location of the lesion, its well-defined nature, the presence of internal opacifications, and lack of expansion. Gray-scale CBCT imaging of the area demonstrated values similar to fatty tissue. This case highlighted the fact that benign developmental variants associated with the skull base share similar radiographic features with more serious pathological entities.

  7. Arrested pneumatization of the sphenoid sinus mimicking intraosseous lesions of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Jalali, Elnaz; Tadinada, Aditya [Dept. of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington (United States)

    2015-03-15

    Arrested pneumatization of the sphenoid sinus is a developmental variant that is not always well recognized and is often confused with other pathologies associated with the skull base. This report describes the case of a patient referred for cone-beam computed tomography (CBCT) imaging for dental implant therapy. CBCT demonstrated a well-defined incidental lesion in the left sphenoid sinus with soft tissue-like density and sclerotic borders with internal curvilinear opacifications. The differential diagnoses included intraosseous lipoma, arrested pneumatization of the sphenoid sinus, chondrosarcoma, chondroid chordoma, and ossifying fibroma. The radiographic diagnosis of arrested pneumatization was based on the location of the lesion, its well-defined nature, the presence of internal opacifications, and lack of expansion. Gray-scale CBCT imaging of the area demonstrated values similar to fatty tissue. This case highlighted the fact that benign developmental variants associated with the skull base share similar radiographic features with more serious pathological entities.

  8. Natural history of chondroid skull base lesions - case report and review

    International Nuclear Information System (INIS)

    Long-term follow-up reports on chondroid lesions of the skull base are rarely presented in the literature. There are virtually no data on natural growth rates of these tumors based on MRI obtained over a period of 10 years or longer. We followed a patient who has had such a lesion for more than 12 years. A non-progressive, slight abducens palsy has been the only associated symptom so far. Even though the patient was operated on for an additional intracranial arterio-venous malformation, clinical features and chromosomal testing excluded Maffucci's syndrome. The MRI follow-up in this case provides an extraordinary perspective on the natural history of chondroid skull base tumors. (orig.)

  9. Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

    Energy Technology Data Exchange (ETDEWEB)

    Hauptman, Jason S., E-mail: jhauptman@mednet.ucla.edu [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Barkhoudarian, Garni; Safaee, Michael; Gorgulho, Alessandra [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Tenn, Steven; Agazaryan, Nzhde; Selch, Michael [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); De Salles, Antonio A.F. [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States)

    2012-06-01

    Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

  10. Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

    International Nuclear Information System (INIS)

    Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

  11. A giant vagal schwannoma with unusual extension from skull base to the mediastinum

    Directory of Open Access Journals (Sweden)

    Shenoy S Vijendra

    2015-01-01

    Full Text Available Cervical vagal schwannoma is an extremely rare neoplasm. Middle aged people are usually affected. These tumors usually present as asymptomatic masses. These tumors are almost always benign. Preoperative diagnosis of these lesions is important due to the morbidity associated with its excision. Preoperative tissue diagnosis is not accurate. The imaging modality can be done to assess the extent and for planning the treatment. Surgical excision with preservation of neural origin is the treatment option. Giant vagal schwannomas are extremely rare. Only one case has been reported in the literature till date. There has no reported case of extensive vagal schwannoma from skull base to the mediastinum. Here, we describe the asymptomatic presentation of an unusual appearing giant cervical vagal schwannoma with an extension from skull base to the mediastinum.

  12. Automatic segmentation of the internal carotid arteries through the skull base

    Science.gov (United States)

    Manniesing, Rashindra; Niessen, Wiro J.

    2007-03-01

    An automatic method is presented to segment the internal carotid arteries through the difficult part of the skull base in CT angiography. The method uses the entropy per slice to select a cross sectional plane below the skull base. In this plane 2D circular structures are detected by the Hough transform. The center points are used to initialize a level set which evolves with a prior shape constraint on its topology. In contrast with some related vessel segmentation methods, our approach does not require the acquisition of an additional CT scan for bone masking. Experiments on twenty internal carotids in ten patients show that 19 seed points are correctly identified (95%) and 18 carotids (90%) are successfully segmented without any human interaction.

  13. Extended Distance-based Phylogenetic Analyses Applied to 3D Homo Fossil Skull Evolution

    OpenAIRE

    Waddell, Peter J.

    2014-01-01

    This article shows how 3D geometric morphometric data can be analyzed using newly developed distance-based evolutionary tree inference methods, with extensions to planar graphs. Application of these methods to 3D representations of the skullcap (calvaria) of 13 diverse skulls in the genus Homo, ranging from Homo erectus (ergaster) at about 1.6 mya, all the way forward to modern humans, yields a remarkably clear phylogenetic tree. Various evolutionary hypotheses are tested. Results of these te...

  14. Normal age-related conversion of bone marrow in the skull base. Assessment with MR imaging

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the normal age-related sequence of conversion from hematopoietic to fatty marrow in the skull base by means of MR imaging. We retrospectively reviewed T1-weighted MR images of the skull base for the distribution of hematopoietic and fatty marrow. The subjects consisted of 169 MR examinations that were performed with the spin-echo technique. The age of the subjects ranged from 0 months to 20 years old. Patients with known marrow abnormalities were excluded from this study. Marrow conversion was assessed in the presphenoid, postsphenoid, basiocciput, petrous apex, clivus, zygomatic bone, and condyle of the mandible. The signal intensity was visually graded, and the signal intensity ratio was determined on the basis of the intensities of the subcutaneous fat and air. The signal intensity of all observed regions was as low as that of muscles until 3 months of age. Conversion of hematopoietic to fatty marrow first occurred in the zygomatic bone until 6 months of age. The presphenoid increased in signal intensity from 5 months to 2 years of age, and the sphenoid sinus began to be pneumatic at this age. Marrow conversion of the postsphenoid and basiocciput was later than that of the presphenoid. Most of the bone marrow of the skull base appeared as fatty conversion until 3 years of age, although some mandibular condyles appeared hematopoietic at 3 years of age. The normal age-related conversion from hematopoietic to fatty marrow in the skull base followed a well-defined sequence. Knowledge of the normal bone marrow conversion by MR imaging is essential for the recognition of pathologic marrow processes. (author)

  15. Proton and carbon ion radiotherapy for primary brain tumors and tumors of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E.; Kessel, Kerstin; Habermehl, Daniel; Debus, Jurgen [Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)], e-mail: Stephanie.Combs@med.uni-heidelberg.de; Haberer, Thomas [Heidelberger Ionenstrahl Therapiezentrum (HIT), Heidelberg (Germany); Jaekel, Oliver [Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany); Heidelberger Ionenstrahl Therapiezentrum (HIT), Heidelberg (Germany)

    2013-10-15

    To analyze clinical concepts, toxicity and treatment outcome in patients with brain and skull base tumors treated with photons and particle therapy. Material and methods: In total 260 patients with brain tumors and tumors of the skull base were treated at the Heidelberg Ion Therapy Center (HIT). Patients enrolled in and randomized within prospective clinical trials as well as bony or soft tissue tumors are not included in this analysis. Treatment was delivered as protons, carbon ions, or combinations of photons and a carbon ion boost. All patients are included in a tight follow-up program. The median follow-up time is 12 months (range 2-39 months). Results: Main histologies included meningioma (n = 107) for skull base lesions, pituitary adenomas (n = 14), low-grade gliomas (n = 51) as well as high-grade gliomas (n = 55) for brain tumors. In all patients treatment could be completed without any unexpected severe toxicities. No side effects > CTC Grade III were observed. To date, no severe late toxicities were observed, however, for endpoints such as secondary malignancies or neuro cognitive side effects follow-up time still remains too short. Local recurrences were mainly seen in the group of high-grade gliomas or atypical meningiomas; for benign skull base meningiomas, to date, no recurrences were observed during follow-up. Conclusion: The specific benefit of particle therapy will potentially reduce the risk of secondary malignancies as well as improve neuro cognitive outcome and quality of life (QOL); thus, longer follow-up will be necessary to confirm these endpoints. Indication-specific trials on meningiomas and gliomas are underway to elucidate the role of protons and carbon ions in these indications.

  16. Proton and carbon ion radiotherapy for primary brain tumors and tumors of the skull base

    International Nuclear Information System (INIS)

    To analyze clinical concepts, toxicity and treatment outcome in patients with brain and skull base tumors treated with photons and particle therapy. Material and methods: In total 260 patients with brain tumors and tumors of the skull base were treated at the Heidelberg Ion Therapy Center (HIT). Patients enrolled in and randomized within prospective clinical trials as well as bony or soft tissue tumors are not included in this analysis. Treatment was delivered as protons, carbon ions, or combinations of photons and a carbon ion boost. All patients are included in a tight follow-up program. The median follow-up time is 12 months (range 2-39 months). Results: Main histologies included meningioma (n = 107) for skull base lesions, pituitary adenomas (n = 14), low-grade gliomas (n = 51) as well as high-grade gliomas (n = 55) for brain tumors. In all patients treatment could be completed without any unexpected severe toxicities. No side effects > CTC Grade III were observed. To date, no severe late toxicities were observed, however, for endpoints such as secondary malignancies or neuro cognitive side effects follow-up time still remains too short. Local recurrences were mainly seen in the group of high-grade gliomas or atypical meningiomas; for benign skull base meningiomas, to date, no recurrences were observed during follow-up. Conclusion: The specific benefit of particle therapy will potentially reduce the risk of secondary malignancies as well as improve neuro cognitive outcome and quality of life (QOL); thus, longer follow-up will be necessary to confirm these endpoints. Indication-specific trials on meningiomas and gliomas are underway to elucidate the role of protons and carbon ions in these indications

  17. Scedosporium apiospermum as a rare cause of central skull base osteomyelitis

    Science.gov (United States)

    Jalava-Karvinen, Päivi; Nyman, Mikko; Gardberg, Maria; Harju, Inka; Hohenthal, Ulla; Oksi, Jarmo

    2016-01-01

    We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man. The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms. Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction. PMID:27134821

  18. Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery

    OpenAIRE

    Chaney, Mark A.; Jellish, W Scott; Leonetti, John P.

    1996-01-01

    A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertai...

  19. Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer

    International Nuclear Information System (INIS)

    We describe a 44-year-old woman who presented with an isolated unilateral hypoglossal nerve paralysis caused by a skull base metastasis from breast cancer. The patient had a modified radical mastectomy followed by local radiotherapy and adjuvant chemotherapy. Fourteen months later she presented with difficulty in speaking. Physical examination revealed an isolated left hypoglossal nerve paralysis. The MRI scan showed a mass lesion involving the left occipital condyle extending into hypoglossal canal. Copyright (2001) Blackwell Science Pty Ltd

  20. Teflon Granuloma of the Skull Base: A Complication of Endonasal Brain Surgery

    OpenAIRE

    Soose, Ryan J.; Snyderman, Carl H.; Amin B Kassam

    2007-01-01

    Teflon granuloma is an inflammatory giant-cell foreign-body reaction to polytetrafluoroethylene fibers or injection. Tissue augmentation with Teflon has dramatically declined over the past two decades because of its implication in granuloma formation. Nevertheless, Teflon felt is still commonly used in neurosurgical dissection and microvascular decompression. We report a patient with a Teflon granuloma of the skull base discovered 1.5 years after endonasal resection of an olfactory groove men...

  1. Teamwork in skull base surgery: An avenue for improvement in patient care

    OpenAIRE

    McLaughlin, Nancy; Ricardo L. Carrau; Daniel F. Kelly; Prevedello, Daniel M.; Kassam, Amin B.

    2013-01-01

    Background: During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Methods: Pubmed and Medline databases were searched for pu...

  2. Fat suppression and dynamic MR imaging for postoperative evaluation of the skull base surgery

    International Nuclear Information System (INIS)

    Postoperative T1-weighted spin echo imaging often demonstrate high signal intensities in the surgical area. In tumor cases, it is crucial to determine the nature of high signal intensities because the potentially residual tumor also appears as a high signal area with Gd-DTPA injection. To evaluate the high signal intensity area on postoperative T1-weighted spin echo images, postoperative fat suppression MR imaging and dynamic MR imaging were examined in 53 cases of radically resected skull base tumors. The diagnosis was pituitary adenoma in 29 cases, meningioma in 13 cases, acoustic neurinoma in 10 cases, and ependymoma in one case. In all cases, abdominal fat tissue was placed into dead spaces produces by tumor resection or drilling of the skull base, and into opened air sinus to prevent postoperative cerebro-spinal fluid leakage and postoperative infections. The nature of high signal intensities, such as fat tissues and postoperative hematomas, could be clarified more easily by fat suppression MR imaging than by T1-weighted spin-echo imaging. In five cases, the tumor was not totally resected. The residual tumor could be demonstrated clearly on paramagnetic contrast-enhanced fat suppression MR imagings. On dynamic MR imagings, the time-intensity pattern of residual tumor showed no changes between pre- and postoperative imagings. In conclusion, fat suppression MR imaging and dynamic MR imaging are useful in determining the nature of postoperative high signal intensities after the skull base surgery. (author)

  3. Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery

    Institute of Scientific and Technical Information of China (English)

    李世亭; 潘庆刚; 刘宁涛; 刘忠; 沈峰

    2003-01-01

    Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

  4. Recurrence of Skull Base Meningiomas: The Role of Aggressive Removal in Surgical Treatment.

    Science.gov (United States)

    da Silva, Carlos Eduardo; Peixoto de Freitas, Paulo Eduardo

    2016-06-01

    Objectives The recurrence of meningiomas is a crucial aspect that must be considered during the planning of treatment strategy. The Simpson grade classification is the most relevant surgical aspect to predict the recurrence of meningiomas. We report on a series of patients with recurrent skull base meningiomas who were treated with the goal of radical removal. Design A retrospective study. Setting Hospital Ernesto Dornelles, Porto Alegre, Brazil. Participants Patients with recurrent skull base meningiomas. Main Outcomes Measures The goal of obtaining aggressive resection (i.e., Simpson grades I and II). Results The average age was 54 years, the mean follow-up period was 52.1 months, and Simpson grades I and II were obtained in 82%. The overall mortality was 5.8%. Transient cranial nerve deficits occurred in 11.7%; the definitive morbidity was also 5.8%. A second recurrence occurred in 5.8%. Conclusions Radical removal of recurrent skull base meningiomas is achievable and should be considered an option with a good outcome and an acceptable morbidity. The common surgical finding that was responsible for recurrence in this study was incomplete removal during the first surgery. We recommend extensive dura and bone removal in the surgical treatment of such recurrent lesions. PMID:27175316

  5. [Endovascular management of skull base tumors. A practical review on literature].

    Science.gov (United States)

    Moscote-Salazar, Luis Rafael; Balderrama, Jorge; Alvis-Miranda, Hernando Raphael; Lee, Angel; Alcalá-Cerra, Gabriel

    2014-01-01

    Generally speaking, skull base tumors are very difficult-to-reach lesions. More or less, two thirds of those tumors correspond to meningiomas, which are highly vascular tumors. Tumors that are able to an embolization are juvenile nasopharyngeal angiofibromas, hemangiopericytomas, hemangioblastomas, meningiomas, metastatic lesions, paragangliomas, glomus tumors and other paragangliomas. Pre-operatory embolization of tumors arising in the skull base is a surgical strategy which allows to control probable hemorrhages secondary to the surgical resection of the tumor. The benefits of this sort of embolization have been partially demonstrated. However, there are concrete and objective results, as reduction in bleeding, time of surgery, post-operative hospital stay, and the use of blood transfusion; besides, another benefit reported is the lower morbimortality related to the surgical management of neural tissue and vascular structures. The aim of this article was to bring up to date the available information up to this moment, describe briefly the background of the pre-operative embolization of skull base tumors, and emphasize the knowledge related with the variables of this therapy, such as the types of hypervascular tumors, vascular anatomy related to this (according to type and position of the tumor), the types of embolization therapy in hypervascular tumors, as well as the materials that must be used. PMID:25078745

  6. The Brachyury Gly177Asp SNP Is not Associated with a Risk of Skull Base Chordoma in the Chinese Population

    Directory of Open Access Journals (Sweden)

    Zhen Wu

    2013-10-01

    Full Text Available A recent chordoma cancer genotyping study reveals that the rs2305089, a single nucleotide polymorphism (SNP located in brachyury gene and a key gene in the development of notochord, is significantly associated with chordoma risk. The brachyury gene is believed to be one of the key genes involved in the pathogenesis of chordoma, a rare primary bone tumor originating along the spinal column or at the base of the skull. The association between the brachyury Gly177Asp single nucleotide polymorphism (SNP and the risk of skull base chordoma in Chinese populations is currently unknown. We investigated the genotype distribution of this SNP in 65 skull-base chordoma cases and 120 healthy subjects. Comparisons of the genotype distributions and allele frequencies did not reveal any significant difference between the groups. Our data suggest that the brachyury Gly177Asp SNP is not involved in the risks of skull-base chordoma, at least in the Chinese population.

  7. Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

    Science.gov (United States)

    Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

    2014-01-01

    For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes. PMID:25105146

  8. Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2015-01-01

    Conclusion: Image-based preoperative vascular and neural element segmentation with 3D reconstruction is highly informative preoperatively and could increase the vigilance of neurosurgeons for preventing neurovascular injury during skull base surgeries. Additionally, the accuracy found in this study is superior to previously reported measurements. This novel preliminary study is encouraging for future validation with larger numbers of patients.

  9. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Science.gov (United States)

    ... are in the middle of a live endoscopic pituitary tumor surgery. I'm joined by my colleagues Dr. ... Neurosurgical Specialist based here in Norfolk, Virginia. The pituitary tumor surgery historically has been done using both specialties, ...

  10. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... are in the middle of a live endoscopic pituitary tumor surgery. I'm joined by my colleagues Dr. ... Neurosurgical Specialist based here in Norfolk, Virginia. The pituitary tumor surgery historically has been done using both specialties, ...

  11. Efficacy of navigation in skull base surgery using composite computer graphics of magnetic resonance and computed tomography images

    International Nuclear Information System (INIS)

    The efficacy of a neurosurgical navigation system using three-dimensional composite computer graphics (CGs) of magnetic resonance (MR) and computed tomography (CT) images was evaluated in skull base surgery. Three-point transformation was used for integration of MR and CT images. MR and CT image data were obtained with three skin markers placed on the patient's scalp. Volume-rendering manipulations of the data produced three-dimensional CGs of the scalp, brain, and lesions from the MR images, and the scalp and skull from the CT. Composite CGs of the scalp, skull, brain, and lesion were created by registering the three markers on the three-dimensional rendered scalp images obtained from MR imaging and CT in the system. This system was used for 14 patients with skull base lesions. Three-point transformation using three-dimensional CGs was easily performed for multimodal registration. Simulation of surgical procedures on composite CGs aided in comprehension of the skull base anatomy and selection of the optimal approaches. Intraoperative navigation aided in determination of actual spatial position in the skull base and the optimal trajectory to the tumor during surgical procedures. (author)

  12. State-of-the-art treatment alternatives for base of skull meningiomas: complementing and controversial indications for neurosurgery, stereotactic and robotic based radiosurgery or modern fractionated radiation techniques

    International Nuclear Information System (INIS)

    For skull base meningiomas, several treatment paradigms are available: Observation with serial imaging, surgical resection, stereotactic radiosurgery, radiation therapy or some combination of both. The choice depends on several factors. In this review we evaluate different treatment options, the outcome of modern irradiation techniques as well as the clinical results available, and establish recommendations for the treatment of patients with skull-base meningiomas

  13. The Effects of Clonidine Premedication and Scalp Infiltration of Lidocaine on Hemodynamic Responses to Laryngoscopy and Skull Pin Head-Holder Insertion During Skull Base Procedures

    OpenAIRE

    Jellish, W Scott; Theard, M. Angele; Cheng, Mary Ann; Leonetti, John P.; Crowder, C. Michael; Tempelhoff, Rene

    2001-01-01

    This study was designed to determine if oral clonidine or lidocaine, injected into the scalp before head-holder (H-H) insertion, would attenuate the hemodynamic effects associated with intubation and H-H placement. Thirty-four patients undergoing skull base procedures were randomized to four groups. Group 1 received clonidine 5 mcg/kg po before surgery with 10 to 15 ml of 1% lidocaine infiltrated at pin insertion sites; Group 2 received clonidine with saline infiltration; Group 3 received a p...

  14. The radiological and histopathological differential diagnosis of chordoid neoplasms in skull base

    Directory of Open Access Journals (Sweden)

    PAN Bin-cai

    2013-07-01

    Full Text Available Background Chordoid neoplasms refer to tumors appearing to have histological features of embryonic notochord, which is characterized by cords and lobules of neoplastic cells arranged within myxoid matrix. Because of radiological and histological similarities with myxoid matrix and overlapping immunohistochemical profile, chordoma, chordoid meningioma, chordoid glioma, and rare extraskeletal myxoid chondrosarcoma enter in the radiological and histological differential diagnosis at the site of skull base. However, there is always a great challenge for histopathologists to make an accurate diagnosis when encountering a chordoid neoplasm within or near the central nervous system. The aim of this study is to investigate and summarize the radiological, histological features and immunohistochemical profiles of chordoid neoplasms in skull base, and to find a judicious panel of immunostains to unquestionably help in diagnostically challenging cases. Methods A total of 23 cases of chordoid neoplasms in skull base, including 10 chordomas, 5 chordoid meningiomas, 3 chordoid gliomas and 5 extraskeletal myxoid chondrosarcomas, were collected from the First Affiliated Hospital, Sun Yat-sen University and Guangdong Tongjiang Hospital. MRI examination was performed on the patients before surgical treatment. Microscopical examination and immunohistochemical staining study using vimentin (Vim, pan-cytokeratin (PCK, epithelial membrane antigen (EMA, S?100 protein (S-100, glial fibrillary acidic protein (GFAP, D2-40, Galectin-3, CD3, CD20, Ki-67 were performed on the samples of cases. The clinicopathological data of the patients was also analyzed retrospectively. Results Most of chordomas were localized in the clivus with heterogeneous hyperintensity on T2WI scanning. The breakage of clivus was observed in most cases. Histologically, the tumor cells of chordoma exhibited bland nuclear features and some contained abundant vacuolated cytoplasm (the so

  15. Health-related quality of life in patients with skull base tumours.

    LENUS (Irish Health Repository)

    Kelleher, M O

    2012-02-03

    The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.

  16. Robust Skull-Stripping Segmentation Based on Irrational Mask for Magnetic Resonance Brain Images.

    Science.gov (United States)

    Moldovanu, Simona; Moraru, Luminița; Biswas, Anjan

    2015-12-01

    This paper proposes a new method for simple, efficient, and robust removal of the non-brain tissues in MR images based on an irrational mask for filtration within a binary morphological operation framework. The proposed skull-stripping segmentation is based on two irrational 3 × 3 and 5 × 5 masks, having the sum of its weights equal to the transcendental number π value provided by the Gregory-Leibniz infinite series. It allows maintaining a lower rate of useful pixel loss. The proposed method has been tested in two ways. First, it has been validated as a binary method by comparing and contrasting with Otsu's, Sauvola's, Niblack's, and Bernsen's binary methods. Secondly, its accuracy has been verified against three state-of-the-art skull-stripping methods: the graph cuts method, the method based on Chan-Vese active contour model, and the simplex mesh and histogram analysis skull stripping. The performance of the proposed method has been assessed using the Dice scores, overlap and extra fractions, and sensitivity and specificity as statistical methods. The gold standard has been provided by two neurologist experts. The proposed method has been tested and validated on 26 image series which contain 216 images from two publicly available databases: the Whole Brain Atlas and the Internet Brain Segmentation Repository that include a highly variable sample population (with reference to age, sex, healthy/diseased). The approach performs accurately on both standardized databases. The main advantage of the proposed method is its robustness and speed. PMID:25733013

  17. Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery.

    Science.gov (United States)

    Chaney, M A; Jellish, W S; Leonetti, J P

    1996-01-01

    A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management. PMID:17170989

  18. Detection of brain lesions at the skull base using diffusion-weighted imaging with readout-segmented echo-planar imaging and generalized autocalibrating partially parallel acquisitions

    Directory of Open Access Journals (Sweden)

    Xiao-Er Wei

    2011-01-01

    Full Text Available Objective: To analyze the value of readout-segmented echo-planar imaging (rs-EPI with parallel imaging and a two-dimensional (2D navigator-based reacquisition technique in the detection of brain lesions at the skull base. Materials and Methods: A total of 54 patients (male 37, female 17 with suspected skull-base intracranial lesions underwent magnetic resonance imaging (MRI, including pre-T1 weighted imaging, T2-weighted imaging, Fluid Attenuated Inversion Recovery (FLAIR, standard single shot echo-planar imaging diffusion weighted imaging (ss-EPI DWI and rs-EPI DWI, post-contrast T1-weighted. The total number of lesions and the number of lesions at different sites on all MRI sequences were used as reference measures. Then differences in detecting lesions and image quality between standard ss-EPI DWI and rs-EPI DWI were analyzed. Results: There was a significant difference in the total number of lesions detected by rs-EPI DWI and standard ss-EPI DWI (P = 0.01. But this difference was mainly due to an improved ability of rs-EPI DWI to detect lesions located in the anterior cranial fossa, compared to ss-EPI DWI (P=0.02; the ability of ss-EPI and rs-EPI DWI to detect lesions in the middle cranial fossa and posterior cranial fossa was not significantly different (P = 0.471, P = 0.486, respectively. For image quality, rs-EPI images were significantly better than standard ss-EPI DWI images (P<0.001. Conclusion: The rs-EPI DWI technique is a useful tool for the detection and evaluation of lesions located at the skull base.

  19. MRI signal changes in the skull base bone after endoscopic nasopharyngectomy for recurrent NPC: A serial study of 9 patients

    International Nuclear Information System (INIS)

    Purpose: This study was focused on the serial changes in magnetic resonance images (MRI) of the skull-base bone that occur after endoscopic nasopharyngectomy in patients with local recurrent nasopharyngeal carcinoma (rNPC). Materials and methods: Nine patients with histologically proven rNPC were enrolled in this study. Two experienced radiologists independently reviewed all presurgical and postsurgical MR images for each patient. Results: At 36 sites on the skull base, the MRI signal underwent a change after surgery, which took the form of a heterogeneous pattern of hypointense regions with moderate contrast enhancement on T1WI. The onset of changes ranged between 2 weeks and 3 months after surgery. For 21 of the sites, the changes subsided over the course of follow-up, while in 6 they remained stable. At 9 sites, the alteration MRI signal became more pronounced with time. Changes were more common on the homolateral side of the skull base with respect to the recurrent tumor (P < 0.05). The skull-base bone adjacent to the resection boundary had a higher incidence of signal change than nonadjacent areas (P < 0.05). Conclusions: MRI changes in the skull base bone, having a number of distinguishing characteristics, appear to be a common sequel to endoscopic nasopharyngectomy for rNPC

  20. Applied Anatomy of the Neurovascular Structures of the Base of the Skull

    Directory of Open Access Journals (Sweden)

    Rosso, María Victoria

    2011-12-01

    Full Text Available Variations of the anatomy of the vascular system or various pathological processes like intracranial aneurysms could cause neurological symptoms, due to their proximity to cranial nerves. The aim of this study is to describe the link between vessels and cranial nerves, to associate with neurological clinic.24 anatomical pieces were used, 10 of them with repletion of the vascular tree with coloured latex and 12 skulls, observed with magnifying glasses, and through surgical microscope. Images database was used to elaborate this study. The neurovascular relations observed during the dissection including, in cephalocaudal sense, the followings:a. Optic nerve [II] with internal carotid artery and ophthalmic artery.b. Oculomotor nerve [III] with posterior cerebral artery, superior cerebellar artery and posterior communicating artery.c. Trochlear nerve [IV] with superior cerebellar artery.d. Trigeminal nerve [V] with superior cerebellar arterye. Facial nerve [VII] with anterior- inferior cerebellar artery.f. Glossopharyngeal nerve [IX] with posterior- inferior cerebellar artery.The close neurovascular links can explain various neurological manifestations and understand different neurosurgical approaches.The knowledge of the neurovascular relations provides students a useful tool to understand the clinic. In addition, it improves physicians’ daily practice.

  1. Risk factors for brain injury after carbon ion radiotherapy for skull base tumors

    International Nuclear Information System (INIS)

    Background and purpose: This study aimed to determine the risk factors for radiation-induced brain injury (RIBI) after carbon ion radiotherapy (CIRT) for treating skull base tumors. Materials and methods: Between April 1997 and January 2009, CIRT at a total dose of 48.0–60.8 Gy equivalent (GyE) was administered in 16 fractions to 47 patients with skull base tumors. Of these patients, 39 who were followed up with magnetic resonance imaging (MRI) for more than 24 months were analyzed. RIBI was assessed according to the MRI findings based on the Late Effects of Normal Tissue-Subjective, Objective, Management, Analytic criteria; clinical symptoms were assessed according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer tables. The correlations of clinical and dosimetric parameters with incidence of ⩾grade 2 RIBI were retrospectively analyzed. Results: The median follow-up period was 67 months. The 5-year actuarial likelihoods of ⩾grade 2 RIBI and ⩾grade 2 clinical symptoms were 24.5% and 7.0%, respectively. Multivariate analysis demonstrated that the brain volume receiving more than 50 GyE (V50) was a significant risk factor for the development of ⩾grade 2 RIBI (p = 0.004). Conclusion: V50 was a significant risk factor for ⩾grade 2 RIBI after CIRT using a 16-fraction regimen

  2. CT evaluation of Chamberlain's, McGregor's, and McRae's skull-base lines

    International Nuclear Information System (INIS)

    Aim: To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (Chamberlain's, McGregor's, and McRae's lines) on computed tomography (CT) imaging. To compare these measurements to previously documented plain radiograph and magnetic resonance imaging (MRI) measurements. Materials and methods: Reformatted midline sagittal CT images of 150 adults were retrospectively evaluated. The shortest perpendicular distance was measured from the Chamberlain's, McGregor's and McRae's baselines for each subject to the odontoid tip. Statistical analysis was performed to compare the CT data with the previously obtained MRI and plain film data. Results: The mean position of the odontoid process was 1.4 mm below Chamberlain's line (median 1.2 mm, SD 2.4 mm), 0.8 mm (median 0.9 mm, SD 3 mm) below McGregor's line and 5 mm (median 5 mm, SD 1.8 mm) below McRae's line. There is no significant difference between male and female results (p > 0.05) or between these CT and previous MRI measurements (p > 0.05). Conclusion: These results provide the mean and range of normal distance from the odontoid process to the most frequently used skull-base lines on the current population on CT

  3. Trigemino-cardiac reflex during skull-base neurosurgeries: a case report

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Khajavi

    2013-11-01

    Full Text Available Background: The Trigemino-cardiac reflex (TCR has been studied as a phenomenon including; bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing, sensory neural hearing loss, nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However, it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally, it was treated by administration of a single dose of atropine (0.5mg/IV and did not happen again.Conclusion: The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches, especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence, immediately.

  4. Optimization of stereotactic radiotherapy treatment delivery technique for base-of-skull meningiomas.

    Science.gov (United States)

    Clark, Brenda G; Candish, Charles; Vollans, Emily; Gete, Ermias; Lee, Richard; Martin, Monty; Ma, Roy; McKenzie, Michael

    2008-01-01

    This study compares static conformal field (CF), intensity modulated radiotherapy (IMRT), and dynamic arcs (DA) for the stereotactic radiotherapy of base-of-skull meningiomas. Twenty-one cases of base-of-skull meningioma (median planning target volume [PTV] = 21.3 cm3) previously treated with stereotactic radiotherapy were replanned with each technique. The plans were compared for Radiation Therapy Oncology Group conformity index (CI) and homogeneity index (HI), and doses to normal structures at 6 dose values from 50.4 Gy to 5.6 Gy. The mean CI was 1.75 (CF), 1.75 (DA), and 1.66 (IMRT) (p size of the PTV (Spearman's rho = -0.53, p = 0.01) and at PTV sizes above 25 cm3, the CI (IMRT) was always superior to CI (DA) and CI (CF). At PTV sizes below 25 cm3, there was no significant difference in CI between each technique. There was no significant difference in HI between plans. The total volume of normal tissue receiving 50.4, 44.8, and 5.6 Gy was significantly lower when comparing IMRT to CF and DA plans (p conformity and normal tissue sparing, in particular for the brain stem and ipsilateral temporal lobe. PMID:18674690

  5. Optimization of Stereotactic Radiotherapy Treatment Delivery Technique for Base-Of-Skull Meningiomas

    International Nuclear Information System (INIS)

    This study compares static conformal field (CF), intensity modulated radiotherapy (IMRT), and dynamic arcs (DA) for the stereotactic radiotherapy of base-of-skull meningiomas. Twenty-one cases of base-of-skull meningioma (median planning target volume [PTV] = 21.3 cm3) previously treated with stereotactic radiotherapy were replanned with each technique. The plans were compared for Radiation Therapy Oncology Group conformity index (CI) and homogeneity index (HI), and doses to normal structures at 6 dose values from 50.4 Gy to 5.6 Gy. The mean CI was 1.75 (CF), 1.75 (DA), and 1.66 (IMRT) (p 3, the CI (IMRT) was always superior to CI (DA) and CI (CF). At PTV sizes below 25 cm3, there was no significant difference in CI between each technique. There was no significant difference in HI between plans. The total volume of normal tissue receiving 50.4, 44.8, and 5.6 Gy was significantly lower when comparing IMRT to CF and DA plans (p 3, due to improved conformity and normal tissue sparing, in particular for the brain stem and ipsilateral temporal lobe

  6. Role of MR imaging in evaluation of neoplastic lesions of the skull base

    International Nuclear Information System (INIS)

    Twenty-five patients with known neoplasms and clinical evidence of involvement of the skull base were evaluated by CT (General Electric 9800) and MR imaging (General Electric Signa, 1.5 T). The studies were evaluated independently for evidence and extent of the disease. Fourteen lesions were considered to be extensive and these were equally well demonstrated by both MR imaging and CT. MR imaging offered superior visualization of the relationship of the tumor mass to the vascular structures. In six patients, the CT scan was considered to show the extent of bone disease better than the MR image did. In five equivocal cases, all located with the sphenoid bone, MR images showed abnormal signal arising from the clivus. This was evident on T1-weighted images as decreased intensity of the clivus on the sagittal view indicating replacement of bone marrow. The authors' experience indicates that the majority of the lesions of the skull base are equally well evaluated by both modalities. However, MR imaging is superior in assessment of the lesions arising from the sphenoid bone

  7. Proton radiation therapy for chordomas and chondrosarcomas of the skull base.

    Science.gov (United States)

    Hug, E B; Slater, J D

    2000-10-01

    Most patients with conventional radiotherapy after surgery die with local disease progression. The superior local tumor control and overall survival achieved with fractionated proton RT can be attributed to improved dose localization characteristics of protons, resulting in higher doses delivered. Patients with base of skull neoplasms are increasingly considered for stereotactic radiosurgery. Recently, Muthukumar et al reported for the University of Pittsburgh group on cobalt-60 Gamma Knife (Elekta Instruments, Atlanta, GA) therapy for 15 patients with chordomas or chondrosarcomas of the base of the skull. With tumor volumes ranging between 0.98 and 10.3 mL (mean, 4.6 mL), doses to the tumor margin varying from 12 to 20 Gy (median, 18 Gy) were delivered. Two patients were treated without histologic tumor confirmation. After a median follow-up time of 40 months, 2 patients had died of disease, 2 patients had succumbed to intercurrent disease, and 1 patient surviving at the time of analysis had developed tumor progression. Neither actuarial local control nor actuarial survival data were presented. In the LLUMC series, most tumors exceeded sizes reportedly suitable for radiosurgery or were of a highly irregular configuration. Nevertheless, in 11 patients, tumors less than 15 mL in size remained locally controlled as did tumors sized between 15 and 25 mL in 11 additional patients; these patients were thus potential candidates for stereotactic radiosurgery. At present, too few reports on radiosurgery contain sufficient patient numbers and statistical analyses to permit one to draw conclusions about the feasibility of radiosurgery for chordomas and chondrosarcomas of the base of the skull. A principal difference between proton RT and radiosurgery as currently practiced in most centers concerns target definition. In proton RT, the GTV is treated. In addition, a clinical volume is defined, which is distinctly different from the GTV in size and shape, to include the

  8. Atlas and feature based 3D pathway visualization enhancement for skull base pre-operative fast planning from head CT

    Science.gov (United States)

    Aghdasi, Nava; Li, Yangming; Berens, Angelique; Moe, Kris S.; Bly, Randall A.; Hannaford, Blake

    2015-03-01

    Minimally invasive neuroendoscopic surgery provides an alternative to open craniotomy for many skull base lesions. These techniques provides a great benefit to the patient through shorter ICU stays, decreased post-operative pain and quicker return to baseline function. However, density of critical neurovascular structures at the skull base makes planning for these procedures highly complex. Furthermore, additional surgical portals are often used to improve visualization and instrument access, which adds to the complexity of pre-operative planning. Surgical approach planning is currently limited and typically involves review of 2D axial, coronal, and sagittal CT and MRI images. In addition, skull base surgeons manually change the visualization effect to review all possible approaches to the target lesion and achieve an optimal surgical plan. This cumbersome process relies heavily on surgeon experience and it does not allow for 3D visualization. In this paper, we describe a rapid pre-operative planning system for skull base surgery using the following two novel concepts: importance-based highlight and mobile portal. With this innovation, critical areas in the 3D CT model are highlighted based on segmentation results. Mobile portals allow surgeons to review multiple potential entry portals in real-time with improved visualization of critical structures located inside the pathway. To achieve this we used the following methods: (1) novel bone-only atlases were manually generated, (2) orbits and the center of the skull serve as features to quickly pre-align the patient's scan with the atlas, (3) deformable registration technique was used for fine alignment, (4) surgical importance was assigned to each voxel according to a surgical dictionary, and (5) pre-defined transfer function was applied to the processed data to highlight important structures. The proposed idea was fully implemented as independent planning software and additional data are used for verification and

  9. 3-D-conformal radiation therapy for pediatric giant cell tumors of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Hug, E.B. [Massachusetts General Hospital, Boston, MA (United States). Dept. of Radiation Oncology; Harvard Univ., Cambridge, MA (United States). Cyclotron Lab.; Dartmouth Hitchcock Medical Center, Lebanon, NH (United States). Section of Radiation Oncology; Muenter, M.W.; Vries, A. de [Massachusetts General Hospital, Boston, MA (United States). Dept. of Radiation Oncology; Adams, J.A.; Munzenrider, J.E. [Massachusetts General Hospital, Boston, MA (United States). Dept. of Radiation Oncology; Harvard Univ., Cambridge, MA (United States). Cyclotron Lab.; Rosenberg, A.E. [Massachusetts General Hospital, Boston, MA (United States). Dept. of Pathology

    2002-05-01

    Background: Giant cell tumors (GCT) of the base of skull are rare neoplasms. This report reviews the treatment of four pediatric patients presenting with aggressive giant cell tumor, using fractionated and combined, conformal proton and photon radiation therapy at Massachusetts General Hospital and Harvard Cyclotron Laboratory. Patients and Methods: Three female patients and one adolescent male, ages 10-15 years, had undergone prior, extensive surgical resection(s) and were treated for either primary (two patients) or recurrent (two patients) disease. Gross residual tumor was evident in three patients and microscopic disease suspected in one patient. Combined proton and photon radiation theory was based on three-dimensional (3-D) planning, consisting of fractionated treatment, one fraction per day at 1.8 CGE (cobalt-gray equivalent) to total target doses of 57.6, 57.6, 59.4, and 61.2 Gy/CGE. Results: With observation times of 3.1 years, 3.3, 5.3, and 5.8 years, all four patients were alive and well and remained locally controlled without evidence of recurrent disease. Except for one patient with partial pituitary insufficiency following radiotherapy for sellar recurrent disease, thus far no late effects attributable to radiation therapy have been observed. Conclusions: 3-D conformal radiation therapy offers a realistic chance of tumor control for aggressive giant cell tumor in the skull base, either postoperatively or at time of recurrence. Conformal treatment techniques allow the safe delivery of relatively high radiation doses in the pediatric patient without apparent increase of side effects. (orig.)

  10. Evaluation of normal and pathologic appearance in skull base and brain stem with metrizamide CT cisternography

    International Nuclear Information System (INIS)

    Metrizamide CT cisternography was performed in accordance with prone 600 head-down method, to study the normal anatomy of the skull base and brain stem. Cases of empty sellae, Rathke's cleft cyst, mucocele trigeminal neurinoma, pons glioma, acoustic neurinoma and jugular foramen tumor were studied together. As side effects of MCTC there were headache, vomiting and appearance of slow waves on EEG, but no convulsion. Transient encephalopathy was noted when 250 mgI/ml, 12 ml, was used. Using MCTC, it is possible to identify the vertebral artery, posterior inferior cerebellar artery, basillar artery, vessels forming Willis ring as well as II, III, V, VII and VIII cranial nerves. Further, by measuring the brain stem parts on various levels, it may become possible to detect early changes of degenerative disease. (author)

  11. Value of Free-Run Electromyographic Monitoring of Lower Cranial Nerves in Endoscopic Endonasal Approach to Skull Base Surgeries

    OpenAIRE

    Thirumala, Parthasarathy D.; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J.; Balzer, Jeffrey

    2012-01-01

    Objective The main objective of this study was to evaluate the value of free-run electromyography (f-EMG) monitoring of cranial nerves (CNs) VII, IX, X, XI, and XII in skull base surgeries performed using endoscopic endonasal approach (EEA) to reduce iatrogenic CN deficits.

  12. Giant cell reparative granuloma of the base of the skull in a 4-month-old infant - CT findings

    International Nuclear Information System (INIS)

    An unusual case of giant cell reparative granuloma of the base of the skull of a 4-month-old infant is described. Computerized tomography was useful in defining extent of the lesion and soft tissue abnormalities. Differential diagnosis with other giant cell lesions is discussed. (orig.)

  13. Systemic therapy for selected skull base sarcomas: Chondrosarcoma, chordoma, giant cell tumour and solitary fibrous tumour/hemangiopericytoma.

    Science.gov (United States)

    Colia, Vittoria; Provenzano, Salvatore; Hindi, Nadia; Casali, Paolo G; Stacchiotti, Silvia

    2016-01-01

    This review highlights the data currently available on the activity of systemic therapy in chondrosarcoma, chordoma, giant cell tumour of the bone (GCTB) and solitary fibrous tumour, i.e., four rare sarcomas amongst mesenchymal malignancy arising from the skull base. PMID:27330421

  14. The cranial base of Australopithecus afarensis: new insights from the female skull

    OpenAIRE

    Kimbel, William H.; Rak, Yoel

    2010-01-01

    Cranial base morphology differs among hominoids in ways that are usually attributed to some combination of an enlarged brain, retracted face and upright locomotion in humans. The human foramen magnum is anteriorly inclined and, with the occipital condyles, is forwardly located on a broad, short and flexed basicranium; the petrous elements are coronally rotated; the glenoid region is topographically complex; the nuchal lines are low; and the nuchal plane is horizontal. Australopithecus afarens...

  15. Effect of skull flexural properties on brain response during dynamic head loading - biomed 2013.

    Science.gov (United States)

    Harrigan, T P; Roberts, J C; Ward, E E; Carneal, C M; Merkle, A C

    2013-01-01

    The skull-brain complex is typically modeled as an integrated structure, similar to a fluid-filled shell. Under dynamic loads, the interaction of the skull and the underlying brain, cerebrospinal fluid, and other tissue produces the pressure and strain histories that are the basis for many theories meant to describe the genesis of traumatic brain injury. In addition, local bone strains are of interest for predicting skull fracture in blunt trauma. However, the role of skull flexure in the intracranial pressure response to blunt trauma is complex. Since the relative time scales for pressure and flexural wave transmission across the skull are not easily separated, it is difficult to separate out the relative roles of the mechanical components in this system. This study uses a finite element model of the head, which is validated for pressure transmission to the brain, to assess the influence of skull table flexural stiffness on pressure in the brain and on strain within the skull. In a Human Head Finite Element Model, the skull component was modified by attaching shell elements to the inner and outer surfaces of the existing solid elements that modeled the skull. The shell elements were given the properties of bone, and the existing solid elements were decreased so that the overall stiffness along the surface of the skull was unchanged, but the skull table bending stiffness increased by a factor of 2.4. Blunt impact loads were applied to the frontal bone centrally, using LS-Dyna. The intracranial pressure predictions and the strain predictions in the skull were compared for models with and without surface shell elements, showing that the pressures in the mid-anterior and mid-posterior of the brain were very similar, but the strains in the skull under the loads and adjacent to the loads were decreased 15% with stiffer flexural properties. Pressure equilibration to nearly hydrostatic distributions occurred, indicating that the important frequency components for typical

  16. Automatic Sex Determination of Skulls Based on a Statistical Shape Model

    Directory of Open Access Journals (Sweden)

    Li Luo

    2013-01-01

    Full Text Available Sex determination from skeletons is an important research subject in forensic medicine. Previous skeletal sex assessments are through subjective visual analysis by anthropologists or metric analysis of sexually dimorphic features. In this work, we present an automatic sex determination method for 3D digital skulls, in which a statistical shape model for skulls is constructed, which projects the high-dimensional skull data into a low-dimensional shape space, and Fisher discriminant analysis is used to classify skulls in the shape space. This method combines the advantages of metrical and morphological methods. It is easy to use without professional qualification and tedious manual measurement. With a group of Chinese skulls including 127 males and 81 females, we choose 92 males and 58 females to establish the discriminant model and validate the model with the other skulls. The correct rate is 95.7% and 91.4% for females and males, respectively. Leave-one-out test also shows that the method has a high accuracy.

  17. Anterior ethmoidal artery emerging anterior to bulla ethmoidalis: An abnormal anatomical variation in Waardenburg's syndrome

    OpenAIRE

    Wong, Danny K. C.; Shao, Angus; Campbell, Raewyn; Douglas, Richard

    2014-01-01

    In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dom...

  18. Active raster scanning with carbon ions. Reirradiation in patients with recurrent skull base chordomas and chondrosarcomas

    Energy Technology Data Exchange (ETDEWEB)

    Uhl, Matthias; Welzel, Thomas; Oelmann, Jan; Habl, Gregor; Hauswald, Henrik; Jensen, Alexandra; Debus, Juergen; Herfarth, Klaus [University of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Ellerbrock, Malte [Heidelberg Ion Therapy Center (HIT), Heidelberg (Germany)

    2014-07-15

    To evaluate the safety and efficacy of reirradiation with carbon ions in patients with relapse of skull base chordoma and chondrosarcoma. Reirradiation with carbon ions was performed on 25 patients with locally recurrent skull base chordoma (n = 20) or chondrosarcoma (n = 5). The median time between the last radiation exposure and the reirradiation with carbon ions was 7 years. In the past, 23 patients had been irradiated once, two patients twice. Reirradiation was delivered using the active raster scanning method. The total median dose was 51.0 GyE carbon ions in a weekly regimen of five to six fractions of 3 GyE. Local progression-free survival (LPFS) was evaluated using the Kaplan-Meier method; toxicity was evaluated using the NCI Common Terminology Criteria for Adverse Events (CTCAE v.4.03). The treatment could be finished in all patients without interruption. In 80 % of patients, symptom control was achieved after therapy. The 2-year-LPFS probability was 79.3 %. A PTV volume of < 100 ml or a total dose of > 51 GyE was associated with a superior local control rate. The therapy was associated with low acute toxicity. One patient developed grade 2 mucositis during therapy. Furthermore, 12 % of patients had tympanic effusion with mild hypacusis (grade 2), while 20 % developed an asymptomatic temporal lobe reaction after treatment (grade 1). Only one patient showed a grade 3 osteoradionecrosis. Reirradiation with carbon ions is a safe and effective method in patients with relapsed chordoma and chondrosarcoma of the skull base. (orig.) [German] Evaluierung der Sicherheit und Wirksamkeit einer Re-Bestrahlung mittels Kohlenstoffionen bei Patienten mit Lokalrezidiv eines Chordoms und Chondrosarkoms der Schaedelbasis. Bei 25 Patienten mit einem Lokalrezidiv eines Chordoms (n = 20) oder Chondrosarkoms (n = 5) der Schaedelbasis erfolgte eine Re-Bestrahlung mittels Kohlenstoffionen. Die mediane Zeit zwischen letzter Bestrahlung und Re-Bestrahlung mit Kohlenstoffionen

  19. Dose–Volume Relationships Associated With Temporal Lobe Radiation Necrosis After Skull Base Proton Beam Therapy

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, Mark W., E-mail: markmcdonaldmd@gmail.com [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Linton, Okechukwu R. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Calley, Cynthia S.J. [Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (United States)

    2015-02-01

    Purpose: We evaluated patient and treatment parameters correlated with development of temporal lobe radiation necrosis. Methods and Materials: This was a retrospective analysis of a cohort of 66 patients treated for skull base chordoma, chondrosarcoma, adenoid cystic carcinoma, or sinonasal malignancies between 2005 and 2012, who had at least 6 months of clinical and radiographic follow-up. The median radiation dose was 75.6 Gy (relative biological effectiveness [RBE]). Analyzed factors included gender, age, hypertension, diabetes, smoking status, use of chemotherapy, and the absolute dose:volume data for both the right and left temporal lobes, considered separately. A generalized estimating equation (GEE) regression analysis evaluated potential predictors of radiation necrosis, and the median effective concentration (EC50) model estimated dose–volume parameters associated with radiation necrosis. Results: Median follow-up time was 31 months (range 6-96 months) and was 34 months in patients who were alive. The Kaplan-Meier estimate of overall survival at 3 years was 84.9%. The 3-year estimate of any grade temporal lobe radiation necrosis was 12.4%, and for grade 2 or higher radiation necrosis was 5.7%. On multivariate GEE, only dose–volume relationships were associated with the risk of radiation necrosis. In the EC50 model, all dose levels from 10 to 70 Gy (RBE) were highly correlated with radiation necrosis, with a 15% 3-year risk of any-grade temporal lobe radiation necrosis when the absolute volume of a temporal lobe receiving 60 Gy (RBE) (aV60) exceeded 5.5 cm{sup 3}, or aV70 > 1.7 cm{sup 3}. Conclusions: Dose–volume parameters are highly correlated with the risk of developing temporal lobe radiation necrosis. In this study the risk of radiation necrosis increased sharply when the temporal lobe aV60 exceeded 5.5 cm{sup 3} or aV70 > 1.7 cm{sup 3}. Treatment planning goals should include constraints on the volume of temporal lobes receiving

  20. Radiation-Induced Middle Ear and Mastoid Opacification in Skull Base Tumors Treated With Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Gary V. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Ahmed, Salmaan [Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Allen, Pamela [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Gidley, Paul W. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Woo, Shiao Y. [Department of Radiation Oncology, University of Louisville, Louisville, KY (United States); DeMonte, Franco [Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Chang, Eric L. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Mahajan, Anita, E-mail: amahajan@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2011-12-01

    Purpose: To assess the incidence of middle ear (ME) pathology in patients treated with radiotherapy (RT) for skull base tumors. Methods and Materials: A retrospective analysis of 61 patients treated with RT between 2003 and 2008 for skull base tumors was conducted. Clinical outcomes and demographics were reviewed. Dose-volume histogram analysis was performed on the eustachian canal (EC), ME, mastoid air cells, vestibular apparatus, cochlea, internal auditory canal, lateral and posterior nasopharynx, and temporal lobes to relate doses to symptoms and radiographic change. Otomastoid opacification was rated 0 (none), 1 (mild), 2 (moderate), and 3 (severe) by a neuroradiologist blinded to clinical outcomes and doses. Results: The median prescribed dose was 50.4 Gy (range, 14-74 Gy). The ME mean dose was 14 Gy and 34 Gy for Grade 0-1 and 2-3 opacification, respectively (p < 0.0001). The mean mastoid dose was 10 Gy and 26 Gy for Grade 0-1 and 2-3, respectively (p < 0.0001). The mean EC dose was 17 Gy and 32 Gy for Grade 0-1 and 2-3, respectively (p = 0.0001). Otomastoid opacification resolved in 17 of 40 patients (42.5%), at a mean of 17 months after RT (range, 2-45 months). Otomastoid opacification persisted in 23 of 40 patients (57.5%), with a mean follow-up of 23 months (range, 2-55 months). Multivariate analysis showed that mastoid dose >30 Gy (odds ratio = 28.0, p < 0.001) and posterior nasopharynx dose of >30 Gy (odds ratio = 4.9, p = 0.009) were associated with Grade 2-3 effusions, whereas other factors including dose to EC and ME were not significant. Conclusions: A mean RT dose >30 Gy to the mastoid air cells or posterior nasopharynx is associated with increased risk of moderate to severe otomastoid opacification, which persisted in more than half of patients at 2-year follow-up.

  1. Radiosurgery for skull base meningiomas: a study on 230 cases in Iranian Gamma Knife Center

    Directory of Open Access Journals (Sweden)

    Ali Bitara M

    2010-06-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Meningiomas are among the most common tumors of the brain. Skull base meningiomas comprise s major part of brain meningiomas. They are difficult to treat because of proximity to major vital neuro-vascular structures which makes their surgical resection hazardous and fraught with a high rate of complications. Radiosurgery is considered as an alternative efficient way to treat them, which targets the tumor and its supplying vasculature. The standard treatment consists of tumor eradication and its supplying vessels through homogeneous dose of 201 rays of cobalt 60 source."n"nMethods: In a case-series study, we report 230 meningiomas referred to Iraninan Gamma Knife Center, treated by radiosurgery with type C Gamma Knife. Radio-surgery was performed at a mean dose of 15 Gy and 50% isodose."n"nResults: Two hundred and thirty of all meningioma cases refered to our institute were skull base lesions. Eighty (35% were new case and the rest were previously treated microsurgically one or more times. None of the patients died after treatment and the most common post-operative complications were headache (30 patients and peri-tumoral edema (12 patients."n"nConclusion: Tumoral control is defined as reduced tumor volume

  2. Dose–Volume Relationships Associated With Temporal Lobe Radiation Necrosis After Skull Base Proton Beam Therapy

    International Nuclear Information System (INIS)

    Purpose: We evaluated patient and treatment parameters correlated with development of temporal lobe radiation necrosis. Methods and Materials: This was a retrospective analysis of a cohort of 66 patients treated for skull base chordoma, chondrosarcoma, adenoid cystic carcinoma, or sinonasal malignancies between 2005 and 2012, who had at least 6 months of clinical and radiographic follow-up. The median radiation dose was 75.6 Gy (relative biological effectiveness [RBE]). Analyzed factors included gender, age, hypertension, diabetes, smoking status, use of chemotherapy, and the absolute dose:volume data for both the right and left temporal lobes, considered separately. A generalized estimating equation (GEE) regression analysis evaluated potential predictors of radiation necrosis, and the median effective concentration (EC50) model estimated dose–volume parameters associated with radiation necrosis. Results: Median follow-up time was 31 months (range 6-96 months) and was 34 months in patients who were alive. The Kaplan-Meier estimate of overall survival at 3 years was 84.9%. The 3-year estimate of any grade temporal lobe radiation necrosis was 12.4%, and for grade 2 or higher radiation necrosis was 5.7%. On multivariate GEE, only dose–volume relationships were associated with the risk of radiation necrosis. In the EC50 model, all dose levels from 10 to 70 Gy (RBE) were highly correlated with radiation necrosis, with a 15% 3-year risk of any-grade temporal lobe radiation necrosis when the absolute volume of a temporal lobe receiving 60 Gy (RBE) (aV60) exceeded 5.5 cm3, or aV70 > 1.7 cm3. Conclusions: Dose–volume parameters are highly correlated with the risk of developing temporal lobe radiation necrosis. In this study the risk of radiation necrosis increased sharply when the temporal lobe aV60 exceeded 5.5 cm3 or aV70 > 1.7 cm3. Treatment planning goals should include constraints on the volume of temporal lobes receiving higher dose. The EC50

  3. The effects of clonidine premedication and scalp infiltration of lidocaine on hemodynamic responses to laryngoscopy and skull pin head-holder insertion during skull base procedures.

    Science.gov (United States)

    Jellish, W S; Theard, M A; Cheng, M A; Leonetti, J P; Crowder, C M; Tempelhoff, R

    2001-08-01

    This study was designed to determine if oral clonidine or lidocaine, injected into the scalp before head-holder (H-H) insertion, would attenuate the hemodynamic effects associated with intubation and H-H placement. Thirty-four patients undergoing skull base procedures were randomized to four groups. Group 1 received clonidine 5 mcg/kg po before surgery with 10 to 15 ml of 1% lidocaine infiltrated at pin insertion sites; Group 2 received clonidine with saline infiltration; Group 3 received a placebo preoperatively and had lidocaine infiltrated at pin sites; and Group 4 received a placebo with saline infiltrated. All patients had a standard anesthetic titrated to a 10 to 14 Hz EEG endpoint during laryngoscopy and H-H placement. Mean arterial pressure (MAP) was similar between groups during intubation, but heart rate (HR) increased in patients who did not receive clonidine. H-H application increased HR and MAP in Group 4. HR also increased after H-H placement in patients who received oral clonidine, while patients receiving scalp lidocaine or both clonidine and scalp lidocaine had little change in either value. Clonidine attenuated HR increases after laryngoscopy but not after H-H placement. Lidocaine injected at the pin sites reduced HR, and MAP increased after H-H insertion. The combination of oral clonidine and scalp lidocaine blunted hemodynamic responses to both intubation and H-H placement. PMID:17167618

  4. Comparison of Scientific Calipers and Computer-Enabled CT Review for the Measurement of Skull Base and Craniomaxillofacial Dimensions

    OpenAIRE

    Citardi, Martin J; Herrmann, Brian; Hollenbeak, Chris S.; Stack, Brendan C.; Cooper, Margaret; Bucholz, Richard D.

    2001-01-01

    Traditionally, cadaveric studies and plain-film cephalometrics provided information about craniomaxillofacial proportions and measurements; however, advances in computer technology now permit software-based review of computed tomography (CT)-based models. Distances between standardized anatomic points were measured on five dried human skulls with standard scientific calipers (Geneva Gauge, Albany, NY) and through computer workstation (StealthStation 2.6.4, Medtronic Surgical Navigation Techno...

  5. [Skull base fractures in childhood. The role of CT in the accuracy of diagnosis].

    Science.gov (United States)

    Sült, T P; Szever, Z; Mona, T; Kerényi, I; Harmat, G

    1999-03-28

    The authors treated 51 patients suffering from basilar skull fractures between January 1995 and June 1997 following a newly initiated protocol. The effectiveness of recognizing these fractures increased to twice and a half after applying a complex (neurologic, otolaryngologic, ophthalmologic, X-ray and cranial CT) diagnostic examination. CT scans were performed at the slightest suspicion of basilar skull fracture since they provide far more information than the native skull X-ray. A close coherence was observed concerning clinical symptoms, potential complications and the manifested fractures, which helped to draw an exact therapeutical strategy and to prevent potential complications. The authors found X-ray gave satisfactory information only about fractures starting on the vault. In the studied period CT proved the basilar skull fracture in 40 (78%) cases out of the total 51. X-ray did it in only 4 (8%) cases and raised the suspicion of the vault fracture spreading to the cranial floor in 20 (39%) cases. CT did not prove the clinically supposed basilar skull fractures in only 11 (22%) cases compared to 27 (53%) by X-ray. After having consultation with radiologists examination methods were always determined by the clinical picture and the available technical conditions (helical technique, multiplan or 3D-reconstruction). PMID:10349317

  6. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    International Nuclear Information System (INIS)

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  7. MR Imaging with Gadolinium-DTPA in skull-base tumors

    International Nuclear Information System (INIS)

    Twenty-five patients were investigated by MR imaging in order to evaluate the diagnostic value of Gadolinium (Gd)-DTPA in skull-base tumors. The patients were studied with standard acquisition techniques (T1, mixed and T2-weighted images) without contrast medium. The images obtained after intravenous injection of Gd-DTPA. The contrastographic results in the different types of acquisition were evaluated. Thanks to the extra-ordinary increase in contrast resolution it provides, Gd-DTPA allowed the precise evaluation of the lesion and of its perfect spatial definition in all cases. Our experience demonstrated that Gd-DTPA considerably increases the sensitivity of the technique in this anatomical region. On the contrary, as regards the nature of the lesion, the signal did not significantly very after the iv injection of Gd-DTPA in the various kinds of lesion. In addition to the important diagnostic advantages of Gd-DTPA, its excellent tollerability and the absence of side-effects must be stressed

  8. Radiosurgery with photons or protons for benign and malignant tumours of the skull base: a review

    Directory of Open Access Journals (Sweden)

    Amichetti Maurizio

    2012-12-01

    Full Text Available Abstract Stereotactic radiosurgery (SRS is an important treatment option for intracranial lesions. Many studies have shown the effectiveness of photon-SRS for the treatment of skull base (SB tumours; however, limited data are available for proton-SRS. Several photon-SRS techniques, including Gamma Knife, modified linear accelerators (Linac and CyberKnife, have been developed and several studies have compared treatment plan characteristics between protons and photons. The principles of classical radiobiology are similar for protons and photons even though they differ in terms of physical properties and interaction with matter resulting in different dose distributions. Protons have special characteristics that allow normal tissues to be spared better than with the use of photons, although their potential clinical superiority remains to be demonstrated. A critical analysis of the fundamental radiobiological principles, dosimetric characteristics, clinical results, and toxicity of proton- and photon-SRS for SB tumours is provided and discussed with an attempt of defining the advantages and limits of each radiosurgical technique.

  9. Neuropsychological function in adults after high dose fractionated radiation therapy of skull base tumors

    International Nuclear Information System (INIS)

    Purpose: To evaluate the long term effects of high dose fractionated radiation therapy on brain functioning prospectively in adults without primary brain tumors. Methods and Materials: Seventeen patients with histologically confirmed chordomas and low grade chondrosarcomas of the skull base were evaluated with neuropsychological measures of intelligence, language, memory, attention, motor function and mood following surgical resection/biopsy of the tumor prior to irradiation, and then at about 6 months, 2 years and 4 years following completion of treatment. None received chemotherapy. Results: In the patients without tumor recurrence or radiation necrosis, there were no indications of adverse effects on cognitive functioning in the post-acute through the late stages after brain irradiation. Even in patients who received doses of radiation up to 66 Cobalt Gy equivalent through nondiseased (temporal lobe) brain tissue, memory and cognitive functioning remained stable for up to 5 years after treatment. A mild decline in psycho-motor speed was seen in more than half of the patients, and motor slowing was related to higher radiation doses in midline and temporal lobe brain structures. Conclusion: Results suggest that in adults, tolerance for focused radiation is relatively high in cortical brain structures

  10. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

    Energy Technology Data Exchange (ETDEWEB)

    Buch, Karen; Nguyen, Thanh; Norbash, Alex; Mian, Asim [Boston University School of Medicine, Department of Radiology, Boston Medical Center, Boston, MA (United States); Mahoney, Eric; Burke, Peter [Boston University School of Medicine, Department of Surgery, Boston Medical Center, Boston, MA (United States); Libby, Brandon; Calner, Paul [Boston University School of Medicine, Department of Emergency Medicine, Boston Medical Center, Boston, MA (United States)

    2016-02-15

    Blunt cerebrovascular injuries (BCVI) are associated with high morbidity and mortality and can lead to neurological deficits. The established criteria for patients undergoing CT angiography (CTA) for BCVI are broad, and can expose patients to radiation unnecessarily. This study aimed to examine the prevalence of BCVI in patients on CTA and determine presentations associated with the highest rates of BCVI. With IRB approval, patients were selected for CTA screening for BCVI according to a predefined set of criteria at our hospital between 2007 and 2010. Patients were identified from our institution's trauma database. CTAs were retrospectively reviewed for BCVI including vasospasm and dissection. Electronic medical records were reviewed for clinical presentation and hospital course. Of 432 patients, vasospasm (n = 10) and/or dissection (n = 36) were found in 46 patients (10.6 %). BCVI was associated with cervical spine and/or skull-base fracture in 40/46 patients (87 %, P < 0.0001). Significant correlations were seen between dissection and fracture in 31/36 patients (86.2 %, p < 0.0001) and between BCVI and both neurological deficits and fractures (27/44, P < 0.0001). BCVI was significantly associated with cervical and/or skullbase fractures and neurological deficits with coexistent fractures. Patients with these injuries should be prioritized for rapid CTA evaluation for BCVI. (orig.)

  11. Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: a retrospective cohort study

    International Nuclear Information System (INIS)

    Skull base meningiomas commonly present with cranial neuropathies. Fractionated stereotactic radiation therapy (FSRT) has been used to treat these tumors with excellent local control, but rates of improvement in cranial neuropathies have not been well defined. We review the experience at Thomas Jefferson University using FSRT in the management of these patients with a focus on symptom outcomes. We identified 225 cases of skull base meningiomas treated with FSRT at Thomas Jefferson University from 1994 through 2009. The target volume was the enhancing tumor, treated to a standard prescription dose of 54 Gy. Symptoms at the time of RT were classified based on the cranial nerve affected. Logistic regression was performed to determine predictors of symptom improvement after FSRT. The median follow-up time was 4.4 years. In 92% of cases, patients were symptomatic at the time of RT; the most common were impaired visual field/acuity (58%) or extraocular movements (34%). After FSRT, durable improvement of at least one symptom occurred in 57% of cases, including 40% of visual acuity/visual field deficits, and 40% of diplopia/ptosis deficits. Of all symptomatic patients, 27% experienced improvement of at least one symptom within 2 months of the end of RT. FSRT is very effective in achieving improvement of cranial neuropathies from skull base meningiomas, particularly visual symptoms. Over half of treated patients experience a durable improvement of at least one symptom, frequently within 2 months from the end of RT

  12. Detection of brain lesions at the skull base using diffusion-weighted imaging with readout-segmented echo-planar imaging and generalized autocalibrating partially parallel acquisitions

    OpenAIRE

    Xiao-Er Wei; Wen-Bin Li; Ming-Hua Li; Yue-Hua Li; Dan Wang; Yu-Zhen Zhang; Li-Xin Jin

    2011-01-01

    Objective: To analyze the value of readout-segmented echo-planar imaging (rs-EPI) with parallel imaging and a two-dimensional (2D) navigator-based reacquisition technique in the detection of brain lesions at the skull base. Materials and Methods: A total of 54 patients (male 37, female 17) with suspected skull-base intracranial lesions underwent magnetic resonance imaging (MRI), including pre-T1 weighted imaging, T2-weighted imaging, Fluid Attenuated Inversion Recovery (FLAIR), standard singl...

  13. Base of the skull morphology and Class III malocclusion in patients with unilateral cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Mariana Maciel Tinano

    2015-02-01

    Full Text Available OBJECTIVE: The aim of the present study was to determine the morphological differences in the base of the skull of individuals with cleft lip and palate and Class III malocclusion in comparison to control groups with Class I and Class III malocclusion. METHODS: A total of 89 individuals (males and females aged between 5 and 27 years old (Class I, n = 32; Class III, n = 29; and Class III individuals with unilateral cleft lip and palate, n = 28 attending PUC-MG Dental Center and Cleft Lip/Palate Care Center of Baleia Hospital and PUC-MG (CENTRARE were selected. Linear and angular measurements of the base of the skull, maxilla and mandible were performed and assessed by a single calibrated examiner by means of cephalometric radiographs. Statistical analysis involved ANCOVA and Bonferroni correction. RESULTS: No significant differences with regard to the base of the skull were found between the control group (Class I and individuals with cleft lip and palate (P > 0.017. The cleft lip/palate group differed from the Class III group only with regard to CI.Sp.Ba (P = 0.015. Individuals with cleft lip and palate had a significantly shorter maxillary length (Co-A in comparison to the control group (P < 0.001. No significant differences were found in the mandible (Co-Gn of the control group and individuals with cleft lip and palate (P = 1.000. CONCLUSION: The present findings suggest that there are no significant differences in the base of the skull of individuals Class I or Class III and individuals with cleft lip and palate and Class III malocclusion.

  14. Stereotactic Ablative Radiosurgery for Locally-Advanced or Recurrent Skull Base Malignancies with Prior External Beam Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Karen Mann Xu

    2015-03-01

    Full Text Available Purpose: Stereotactic ablative radiotherapy (SABR is an attractive modality to treat malignancies invading the skull base as it can deliver a highly conformal dose with minimal toxicity. However, variation exists in the prescribed dose and fractionation. The purpose of our study is to examine the local control, survival and toxicities in SABR for the treatment of malignant skull base tumors. Methods and Materials: A total of 31 patients and 40 locally-advanced or recurrent head and neck malignancies involving the skull base treated with a common SABR regimen which delivers a radiation dose of 44 Gy in 5 fractions from January 1st, 2004 to December 31st, 2013 were retrospectively reviewed. The local control rate (LC, progression-free survival rate (PFS, overall survival rate (OS and toxicities were reported.Results: The median follow-up time of all patients was 11.4 months (range: 0.6-67.2 months. The median tumor volume was 27 cm3 (range: 2.4-205 cm3. All patients received prior EBRT with a median radiation dose of 64 Gy (range: 24-75.6 Gy delivered in 12 to 42 fractions. 20 patients had surgeries prior to SABR. 19 patients received chemotherapy. Specifically, 8 patients received concurrent cetuximab (ErbituxTM with SABR. The median time-to-progression (TTP was 3.3 months (range: 0-16.9 months. For the 29 patients (93.5% who died, the median time from the end of first SABR to death was 10.3 months (range: 0.5-41.4 months. The estimated 1-year overall survival (OS rate was 35%. The estimated 2-year OS rate was 12%. Treatment was well-tolerated without grade 4 or 5 treatment-related toxicities.Conclusions: SABR has been shown to achieve low toxicities in locally-advanced or recurrent, previously irradiated head and neck malignancies invading the skull base.

  15. Efficacy of Navigation in Skull Base Surgery using Composite Computer Graphics of Magnetic Resonance and Computed Tomography Images

    OpenAIRE

    Hayashi, Nakamasa; Kurimoto, Masanori; Hirashima, Yutaka; Ikeda, Hiroaki; Shibata, Takashi; Tomita, Takahiro; Endo, Shunro

    2001-01-01

    The efficacy of a neurosurgical navigation system using three-dimensional composite computer graphics (CGs) of magnetic resonance (MR) and computed tomography (CT) images was evaluated in skull base surgery. Three-point transformation was used for integration of MR and CT images. MR and CT image data were obtained with three skin markers placed on the patient's scalp. Volume-rendering manipulations of the data produced three-dimensional CGs of the scalp, brain, and lesions from the MR images,...

  16. Usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base: comparison with FDG-PET

    Directory of Open Access Journals (Sweden)

    Ito Shin

    2012-02-01

    Full Text Available Abstract Background Choline is a new PET tracer that is useful for the detection of malignant tumor. Choline is a precursor of the biosynthesis of phosphatidylcholine, a major phospholipid in the cell membrane of eukaryotic cells. Malignant tumors have an elevated level of phosphatidylcholine in cell membrane. Thus, choline is a marker of tumor malignancy. Method The patient was a 51-year-old man with repeated recurrent hemangiopericytoma in the skull base. We performed Choline-PET in this patient after various treatments and compared findings with those of FDG-PET. Results Choline accumulated in this tumor, but FDG did not accumulate. We diagnosed this tumor as residual hemangiopericytoma and performed the resection of the residual tumor. FDG-PET is not appropriate for skull base tumor detection because uptake in the brain is very strong. Conclusion We emphasize the usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base after various treatments, compared with FDG-PET.

  17. High-resolution Whole-Genome Analysis of Skull Base Chordomas Implicates FHIT Loss in Chordoma Pathogenesis12

    Science.gov (United States)

    Diaz, Roberto Jose; Guduk, Mustafa; Romagnuolo, Rocco; Smith, Christian A; Northcott, Paul; Shih, David; Berisha, Fitim; Flanagan, Adrienne; Munoz, David G; Cusimano, Michael D; Pamir, M Necmettin; Rutka, James T

    2012-01-01

    Chordoma is a rare tumor arising in the sacrum, clivus, or vertebrae. It is often not completely resectable and shows a high incidence of recurrence and progression with shortened patient survival and impaired quality of life. Chemotherapeutic options are limited to investigational therapies at present. Therefore, adjuvant therapy for control of tumor recurrence and progression is of great interest, especially in skull base lesions where complete tumor resection is often not possible because of the proximity of cranial nerves. To understand the extent of genetic instability and associated chromosomal and gene losses or gains in skull base chordoma, we undertook whole-genome single-nucleotide polymorphism microarray analysis of flash frozen surgical chordoma specimens, 21 from the clivus and 1 from C1 to C2 vertebrae. We confirm the presence of a deletion at 9p involving CDKN2A, CDKN2B, and MTAP but at a much lower rate (22%) than previously reported for sacral chordoma. At a similar frequency (21%), we found aneuploidy of chromosome 3. Tissue microarray immunohistochemistry demonstrated absent or reduced fragile histidine triad (FHIT) protein expression in 98% of sacral chordomas and 67%of skull base chordomas. Our data suggest that chromosome 3 aneuploidy and epigenetic regulation of FHIT contribute to loss of the FHIT tumor suppressor in chordoma. The finding that FHIT is lost in a majority of chordomas provides new insight into chordoma pathogenesis and points to a potential new therapeutic target for this challenging neoplasm. PMID:23019410

  18. High-resolution Whole-Genome Analysis of Skull Base Chordomas Implicates FHIT Loss in Chordoma Pathogenesis

    Directory of Open Access Journals (Sweden)

    Roberto Jose Diaz

    2012-09-01

    Full Text Available Chordoma is a rare tumor arising in the sacrum, clivus, or vertebrae. It is often not completely resectable and shows a high incidence of recurrence and progression with shortened patient survival and impaired quality of life. Chemotherapeutic options are limited to investigational therapies at present. Therefore, adjuvant therapy for control of tumor recurrence and progression is of great interest, especially in skull base lesions where complete tumor resection is often not possible because of the proximity of cranial nerves. To understand the extent of genetic instability and associated chromosomal and gene losses or gains in skull base chordoma, we undertook whole-genome single-nucleotide polymorphism microarray analysis of flash frozen surgical chordoma specimens, 21 from the clivus and 1 from C1 to C2 vertebrae. We confirm the presence of a deletion at 9p involving CDKN2A, CDKN2B, and MTAP but at a much lower rate (22% than previously reported for sacral chordoma. At a similar frequency (21%, we found aneuploidy of chromosome 3. Tissue microarray immunohistochemistry demonstrated absent or reduced fragile histidine triad (FHIT protein expression in 98% of sacral chordomas and 67%of skull base chordomas. Our data suggest that chromosome 3 aneuploidy and epigenetic regulation of FHIT contribute to loss of the FHIT tumor suppressor in chordoma. The finding that FHIT is lost in a majority of chordomas provides new insight into chordoma pathogenesis and points to a potential new therapeutic target for this challenging neoplasm.

  19. High-resolution whole-genome analysis of skull base chordomas implicates FHIT loss in chordoma pathogenesis.

    Science.gov (United States)

    Diaz, Roberto Jose; Guduk, Mustafa; Romagnuolo, Rocco; Smith, Christian A; Northcott, Paul; Shih, David; Berisha, Fitim; Flanagan, Adrienne; Munoz, David G; Cusimano, Michael D; Pamir, M Necmettin; Rutka, James T

    2012-09-01

    Chordoma is a rare tumor arising in the sacrum, clivus, or vertebrae. It is often not completely resectable and shows a high incidence of recurrence and progression with shortened patient survival and impaired quality of life. Chemotherapeutic options are limited to investigational therapies at present. Therefore, adjuvant therapy for control of tumor recurrence and progression is of great interest, especially in skull base lesions where complete tumor resection is often not possible because of the proximity of cranial nerves. To understand the extent of genetic instability and associated chromosomal and gene losses or gains in skull base chordoma, we undertook whole-genome single-nucleotide polymorphism microarray analysis of flash frozen surgical chordoma specimens, 21 from the clivus and 1 from C1 to C2 vertebrae. We confirm the presence of a deletion at 9p involving CDKN2A, CDKN2B, and MTAP but at a much lower rate (22%) than previously reported for sacral chordoma. At a similar frequency (21%), we found aneuploidy of chromosome 3. Tissue microarray immunohistochemistry demonstrated absent or reduced fragile histidine triad (FHIT) protein expression in 98% of sacral chordomas and 67%of skull base chordomas. Our data suggest that chromosome 3 aneuploidy and epigenetic regulation of FHIT contribute to loss of the FHIT tumor suppressor in chordoma. The finding that FHIT is lost in a majority of chordomas provides new insight into chordoma pathogenesis and points to a potential new therapeutic target for this challenging neoplasm. PMID:23019410

  20. Advanced therapeutic strategy for radiation-induced osteosarcoma in the skull base: a case report and review

    International Nuclear Information System (INIS)

    A review of patients with skull base osteosarcoma secondary to radiation (radiation-induced osteosarcoma: RIOS) of the pituitary tumor shows the mean survival of approximately 7 months (2 weeks – 16 months). This warning prognosis seems to stem from two factors, 1) the anatomical complexity of the skull base for total resection of the tumor, and 2) standard adjuvant therapies for the tumor yet to be established. Contrary to the general belief, the authors report an unusually long survival of a 75-year-old woman with a history of osteosarcoma that developed in the same sequence 20 years after pituitary tumor radiation. On her recent admission, she complained of frontal headaches and MRI studies showed a tumor in the sphenoid sinus. Endoscopic trans-nasal tumor removal allowed for histological diagnosis of an osteosarcoma. However, further rapid tumor growth necessitated a radical tumor resection followed by a combined chemotherapy with ifosfamide, cisplatin, and etoposide (ICE). Despite temporary suppression of the tumor growth, the chemotherapy was discontinued due to severe pancytopenia that occurred after three courses of treatment. Shortly after the discontinuation of ICE therapy, the tumor size increased again rapidly, requiring a novel radiation therapy, Cyber-knife treatment. Following this radiation, the tumor growth was arrested, and the patient remains healthy without neurological symptoms over 24 months. The outcome of Cyber-knife in this case suggests that this specific therapy must be considered for the unresectable skull base RIOS

  1. Clinical role of the skull base with increased uptake of 99mTc-MDP on SPECT/CT fused imaging with patients of nasopharyngeal

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical role of the fused skull single photon emission computed tomographic and computed tomographic images (SPECT/CT) when there was 'hot' in the skull base of patients with NPC. Methods: 99mTc-MDP SPECT/ CT and MRI were performed in a week in 44 patients (30 with first-visited cases and 14 with return-visited, 38 cases of poorly differentiated squamous cell carcinoma and 6 cases of undifferentiated cancer, 14 with headache). Region of interests (ROI) were drawn on the area of the suspected skull base and the upper cervical vertebral body on the same slice. A lesion-to-spine (L/S) ratio was interpreted on SPECT/CT as normal, benign, or malignant. L/S>1 indicated malignant skull base bone involvement (SBBI). Ten patients were studied as controls. Results: (1)Of the 44 study patients, 24 had SBBI (55%) based on SPECT/CT detecting skull base bone lesions with L/S =1.83±0.69. Twenty patients had normal or benign bone lesions on SPECT/CT with L/S =0.68±0.13. There was statistic significance compared SBBI with no SBBI subgroups (P 0.05). The numbers of SBBI had no relationship with positive rate of SPECT/CT (P >0.05). (3)There was no obviously increased uptake in the skull base in the 10 control patients (L/S<1). Conclusion: The skull SPECT/CT was recommended as one of clinical diagnosis tool for SBBI from NPC. Patients with headache should be highly suspected whether tumor cells involved the skull base bone or not. Further accumulation of other clinical factors would clarify the values of SPECT/CT. (authors)

  2. Gross tumor volume (GTV) and clinical target volume (CTV) for radiation therapy of benign skull base tumours; Volume tumoral macroscopique (GTV) et volume-cible anatomoclinique (CTV) dans la radiotherapie des tumeurs benignes de la base du crane

    Energy Technology Data Exchange (ETDEWEB)

    Maire, J.P. [Centre Hospitalier Universitaire de Bordeaux, Hopital Saint Andre, Service d' Oncologie Radiotherapie, 33 - Bordeaux (France); Liguoro, D.; San Galli, F. [Centre Hospitalier Universitaire de Bordeaux, Hopital Saint Andre, Service de Neurochirurgie A, 33 - Bordeaux (France)

    2001-10-01

    Skull base tumours represent a out 35 to 40% of all intracranial tumours. There are now many reports in the literature confirming the fact that about 80 to 90% of such tumours are controlled with fractionated radiotherapy. Stereotactic and 3-dimensional treatment planning techniques increase local control and central nervous system tolerance. Definition of the gross tumor volume (GTV) is generally easy with currently available medical imaging systems and computers for 3-dimensional dosimetry. The definition of the clinical target volume (CTV) is more difficult to appreciate: it is defined from the CTV plus a margin, which depends on the histology and anterior therapeutic history of the tumour. It is important to take into account the visible tumour and its possible extension pathways (adjacent bone, holes at the base of skull) and/or an anatomic region (sella turcica + adjacent cavernous sinus). It is necessary to evaluate these volumes with CT Scan and MRI to appreciate tumor extension in a 3-dimensional approach, in order to reduce the risk of marginal recurrences. The aim of this paper is to discuss volume definition as a function of tumour site and tumour type to be irradiated. (authors)

  3. Influence of MRI abnormality in skull base bone on prognosis of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Purpose. To evaluate the influence of skull base bone (SBB) abnormality showed by MRI on prognosis of nasopharyngeal carcinoma (NPC). Patients and methods. From March 1993 to December 1998, 122 NPC patients received prime radiotherapy treatment. All of them were proved pathologically and checked by magnetic resonance imaging (MRI). Every patient received radiation through conjoint facio-cervical field and conventional dose-fractionation schedules. The total dose to the primary tumor was 60 5 Gy (median, 70 Gy). The Kaplan Meier method, the Log-rank test and the Cox regression model were used to evaluate the significance of prognostic factors on NPC patient survival. Results. The overall median survival period was 50 (6 2) months, and the 1, 3 and 5 year-survival rates were, respectively, 99.2%, 87.9%, and 73.3%. The 1, 3, and 5 year-survival rates of abnormality and normality of the SBB on MRI were 98.9%, 87.2%, 71.9%, and 100.0%, 89.8%, 77.0%, respectively (P 0.4233). Gender, age, head pain, SBB abnormality, cranial nerve palsy, cervical lymphadenopathy and primary tumor extent were analyzed with the Cox regression model and SBB abnormality on MRI did not prove to have statistical significance (P = 0.6934). According to the analysis of regrouping, patients with SBB abnormalities ≥ sites have a worse prognosis (P = 0.0427). Then. the above seven factors are analyzed by Cox regression model and the result had statistical significance (P = 0.0385). Conclusion. The SBB abnormality on MRI is of no obvious influence on prognosis of NPC. However, when SBB abnormality sites were ≥ 2, there is obvious statistical significance on the prognosis. (author)

  4. Importance of precise positioning for proton beam therapy in the base of skull and cervical spine.

    Science.gov (United States)

    Tatsuzaki, H; Urie, M M

    1991-08-01

    Using proton beam therapy, high doses have been delivered to chordomas and chondrosarcomas of the base of skull and cervical spine. Dose inhomogeneity to the tumors has been accepted in order to maintain normal tissue tolerances, and detailed attention to patient immobilization and to precise positioning has minimized the margins necessary to ensure these dose constraints. This study examined the contribution of precise positioning to the better dose localization achieved in these treatments. Three patients whose tumors represented different anatomic geometries were studied. Treatment plans were developed which treated as much of the tumor as possible to 74 Cobalt-Gray-Equivalent (CGE) while maintaining the central brain stem and central spinal cord at less than or equal to 48 CGE, the surface of the brain stem, surface of the spinal cord, and optic structures at less than or equal to 60 CGE, and the temporal lobes at less than or equal to 5% likelihood of complication using a biophysical model of normal tissue complication probability. Two positioning accuracies were assumed: 3 mm and 10 mm. Both proton beam plans and 10 MV X ray beam plans were developed with these assumptions and dose constraints. In all cases with the same positioning uncertainties, the proton beam plans delivered more dose to a larger percentage of the tumor volume and the estimated tumor control probability was higher than with the X ray plans. However, without precise positioning both the proton plans and the X ray plans deteriorated, with a 12% to 25% decrease in estimated tumor control probability. In all but one case, the difference between protons with good positioning and poor positioning was greater than the difference between protons and X rays, both with good positioning. Hence in treating these tumors, which are in close proximity to critical normal tissues, attention to immobilization and precise positioning is essential. With good positioning, proton beam therapy permits higher

  5. Diseases of the skull

    International Nuclear Information System (INIS)

    Different forms of skull diseases viz. inflammatory diseases, skull tumors, primary and secondary bone tumors, are considered. Roentgenograms in some above-mentioned diseases are presented and analysed

  6. Applied Anatomy of the Neurovascular Structures of the Base of the Skull

    OpenAIRE

    Rosso, María Victoria; Pawluk, Gustavo; Pappolla, Agustin; Ferraro, Fernando Martin; Dorman, Matías; Bakken, Sofía María

    2011-01-01

    Variations of the anatomy of the vascular system or various pathological processes like intracranial aneurysms could cause neurological symptoms, due to their proximity to cranial nerves. The aim of this study is to describe the link between vessels and cranial nerves, to associate with neurological clinic.24 anatomical pieces were used, 10 of them with repletion of the vascular tree with coloured latex and 12 skulls, observed with magnifying glasses, and through surgical microscope. Images d...

  7. MRI-detected skull-base invasion. Prognostic value and therapeutic implication in intensity-modulated radiotherapy treatment for nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    With advances in imaging and radiotherapy, the prognostic value of skull-base invasion in nasopharyngeal carcinoma (NPC) needs to be reassessed. We aimed to define a classification system and evaluate the prognostic value of the classification of magnetic resonance imaging (MRI)-detected skull-base invasion in NPC treated with intensity-modulated radiotherapy (IMRT). We retrospectively reviewed 749 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated NPC and treated with IMRT. MRI-detected skull-base invasion was not found to be an independent prognostic factor for overall survival (OS), distant metastasis-free survival (DMFS), local relapse-free survival (LRFS), or disease-free survival (DFS; p > 0.05 for all). Skull-base invasion was classified according to the incidence of each site (type I sites inside pharyngobasilar fascia and clivus vs. type II sites outside pharyngobasilar fascia). The 5-year OS, DMFS, LRFS, and DFS rates in the classification of skull-base invasion in NPC were 83 vs. 67 %, 85 vs.75 %, 95 vs. 88 %, and 76 vs. 62 %, respectively (p < 0.05 for all). Multivariate analysis indicated the classification of skull-base invasion was an independent prognostic factor. MRI-detected skull-base invasion is not an independent prognostic factor in patients with NPC treated with IMRT. However, classification according to the site of invasion has prognostic value. Therefore, patients with various subclassifications of stage T3 disease may receive treatment with different intensities; however, further studies are warranted to prove this. (orig.)

  8. Anatomy of the skull base and the cranial nerves in slice imaging; Anatomie der Schaedelbasis und Hirnnerven in der Schnittbildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Bink, A.; Berkefeld, J.; Zanella, F. [Klinikum der Goethe-Universitaet Frankfurt, Institut fuer Neuroradiologie, Frankfurt am Main (Germany)

    2009-07-15

    Computed tomography (CT) and magnetic resonance imaging (MRI) are suitable methods for examination of the skull base. Whereas CT is used to evaluate mainly bone destruction e.g. for planning surgical therapy, MRI is used to show pathologies in the soft tissue and bone invasion. High resolution and thin slice thickness are indispensible for both modalities of skull base imaging. Detailed anatomical knowledge is necessary even for correct planning of the examination procedures. This knowledge is a requirement to be able to recognize and interpret pathologies. MRI is the method of choice for examining the cranial nerves. The total path of a cranial nerve can be visualized by choosing different sequences taking into account the tissue surrounding this cranial nerve. This article summarizes examination methods of the skull base in CT and MRI, gives a detailed description of the anatomy and illustrates it with image examples. (orig.) [German] Zur Untersuchung der Schaedelbasis sind sowohl die Computertomographie (CT) als auch Magnetresonanztomographie (MRT) geeignet. Waehrend mittels CT vorzugsweise die exakte knoecherne Ausbreitung von Pathologien z. B. zur operativen Therapieplanung erfasst werden, dient die MRT sowohl der Darstellung von Pathologien bzgl. ihrer Ausbreitung im Weichteilgewebe als auch dem Nachweis knoecherner Infiltration. Bei der Untersuchung der Schaedelbasis wird eine hochaufloesende Darstellung mit geringer Schichtdicke fuer beide Modalitaeten angestrebt. Die genaue Kenntnis der Anatomie ist bereits bei der Untersuchungsplanung notwendig. Sie ist zudem Voraussetzung fuer das Erkennen und die korrekte Interpretation von Pathologien. Die MRT ist die bildgebende Methode der Wahl zur Abklaerung von Pathologien der Hirnnerven. Dabei ist es durch gezielte Sequenzauswahl, die sich nach den die Hirnnerven umgebenen Strukturen richtet, moeglich, den gesamten Verlauf der Hirnnerven zu beurteilen. Dieser Artikel beschreibt die Untersuchung der Schaedelbasis

  9. A clinical pilot study of a modular video-CT augmentation system for image-guided skull base surgery

    Science.gov (United States)

    Liu, Wen P.; Mirota, Daniel J.; Uneri, Ali; Otake, Yoshito; Hager, Gregory; Reh, Douglas D.; Ishii, Masaru; Gallia, Gary L.; Siewerdsen, Jeffrey H.

    2012-02-01

    Augmentation of endoscopic video with preoperative or intraoperative image data [e.g., planning data and/or anatomical segmentations defined in computed tomography (CT) and magnetic resonance (MR)], can improve navigation, spatial orientation, confidence, and tissue resection in skull base surgery, especially with respect to critical neurovascular structures that may be difficult to visualize in the video scene. This paper presents the engineering and evaluation of a video augmentation system for endoscopic skull base surgery translated to use in a clinical study. Extension of previous research yielded a practical system with a modular design that can be applied to other endoscopic surgeries, including orthopedic, abdominal, and thoracic procedures. A clinical pilot study is underway to assess feasibility and benefit to surgical performance by overlaying CT or MR planning data in realtime, high-definition endoscopic video. Preoperative planning included segmentation of the carotid arteries, optic nerves, and surgical target volume (e.g., tumor). An automated camera calibration process was developed that demonstrates mean re-projection accuracy (0.7+/-0.3) pixels and mean target registration error of (2.3+/-1.5) mm. An IRB-approved clinical study involving fifteen patients undergoing skull base tumor surgery is underway in which each surgery includes the experimental video-CT system deployed in parallel to the standard-of-care (unaugmented) video display. Questionnaires distributed to one neurosurgeon and two otolaryngologists are used to assess primary outcome measures regarding the benefit to surgical confidence in localizing critical structures and targets by means of video overlay during surgical approach, resection, and reconstruction.

  10. Radiosurgery of small skull-base lesions. No advantage for intensity-modulated stereotactic radiosurgery versus conformal arc technique

    Energy Technology Data Exchange (ETDEWEB)

    Ernst-Stecken, A.; Sauer, R.; Grabenbauer, G. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center, Univ. of Erlangen-Nuremberg, Erlangen (Germany); Lambrecht, U.; Mueller, R. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center, Univ. of Erlangen-Nuremberg, Erlangen (Germany); Div. of Medical Physics, Dept. of Radiation Therapy, Univ. of Erlangen-Nuremberg, Erlangen (Germany); Ganslandt, O.; Fahlbusch, R. [Dept. of Neurosurgery, Univ. of Erlangen-Nuremberg, Erlangen (Germany)

    2005-05-01

    Background and purpose: intensity-modulated stereotactic radiotherapy (IMSRT) has shown the ability to conform the dose to concavities and to better avoid critical organs for large tumors. Given the availability of an electronically driven micro-multileaf collimator, both intensity-modulated stereotactic radiosurgery (IMSRS) and dynamic conformal arc (DCA) technique (DCA) can be performed at the Novalis Shaped Beam Surgery Center, University of Erlangen-Nuremberg, Germany, since 12/2002. This study evaluates both techniques in small skull-base tumors treated with radiosurgery. Material and methods: between 12/2002 and 04/2004, a total of 109 radiosurgical procedures were performed in 77 patients, equally distributed between patients with acoustic neuroma (AN), pituitary adenoma (PA) and meningeoma (M). Six index patients (n = 2 AN, n = 1 PA, n = 3 M) routinely planned for dynamic arc stereotactic radiosurgery were replanned using the IMSRS approach (BrainScan, BrainLAB, Heimstetten, Germany). The RTOG radiosurgery quality assurance guidelines, isodose volumes, doses to organs at risk (OAR), and dose delivery criteria were compared. Results: DCA was superior to IMSRS for homogeneity and coverage. IMSRS could keep the high-dose-irradiated volumes (90% isodose volume) lower than DCA in the PA and AN with very small volumes, but all other lower dose volumes were larger for IMSRS. Dose maxima to OAR were higher for IMSRS. Treatment delivery time for IMSRS would clearly exceed treatment time for DCA by a factor of 2-3. The integral absorbed dose to the brain was much higher in the IMSRS than in the DCA approach (factor 2-3). Conclusion: RTOG radiosurgery guidelines were best met by the DCA rather than IMSRS approach for the treatment of small skull-base lesions. The IMSRS approach will increase the time for planning, dose delivery and integral dose to the brain. Thus, IMSRT techniques are recommended for fractionated stereotactic radiotherapy to larger volumes rather

  11. Feasibility of combined operation and perioperative intensity-modulated brachytherapy of advanced/recurrent malignancies involving the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Strege, R.J.; Eichmann, T.; Mehdorn, H.M. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurosurgery; Kovacs, G.; Niehoff, P. [University Hospital Schleswig-Holstein, Kiel (Germany). Interdisciplinary Brachytherapy Center; Maune, S. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Otolaryngology; Holland, D. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Ophthalmology

    2005-02-01

    Purpose: To assess the technical feasibility and toxicity of combined operation and perioperative intensity-modulated fractionated interstitial brachytherapy (IMBT) in advanced-stage malignancies involving the skull base with the goal of preserving the patients' senses of sight. Patients and Methods: This series consisted of 18 consecutive cases: ten patients with paranasal sinus carcinomas, five with sarcomas, two with primitive neuroectodermal tumors (PNETs), and one with parotid gland carcinoma. After, in most cases, subtotal surgical resection (R1-R2: carried out so that the patients' senses of sight were preserved), two to twelve (mean five) afterloading plastic tubes were placed into the tumor bed. IMBT was performed with an iridium-192 stepping source in pulsed-dose-rate/high-dose-rate (PDR/HDR) afterloading technique. The total IMBT dose, ranging from 10 to 30 Gy, was administered in a fractionated manner (3-5 Gy/day, 5 days/week). Results: Perioperative fractionated IMBT was performed in 15 out of 18 patients and was well tolerated. Complications that partially prevented or delayed IMBT in some cases included cerebrospinal fluid leakage (twice), meningitis (twice), frontal brain syndrome (twice), afterloading tube displacement (twice), seizure (once), and general morbidity (once). No surgery- or radiation-induced injuries to the cranial nerves or eyes occurred. Median survival times were 33 months after diagnosis and 16 months after combined operation and IMBT. Conclusion: Perioperative fractionated IMBT after extensive but vision-preserving tumor resection seems to be a safe and well-tolerated treatment of advanced/recurrent malignancies involving the skull base. These preliminary state suggest that combined operation and perioperative fractionated IMBT is a palliative therapeutic option in the management of fatal malignancies involving the base of the skull, a strategy which leaves the patients' visual acuity intact. (orig.)

  12. Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms

    International Nuclear Information System (INIS)

    The purpose of this study was to retrospectively assess the detection rate of skull-base fractures for three different three-dimensional (3D) reconstruction methods of cranial CT examinations in trauma patients. A total of 130 cranial CT examinations of patients with previous head trauma were subjected to 3D reconstruction of the skull base, using solid (SVR) and transparent (TVR) volume-rendering technique and maximum intensity projection (MIP). Three radiologists independently evaluated all reconstructions as well as standard high-resolution multiplanar reformations (HR-MPRs). Mean fracture detection rates for all readers reading rotating reconstructions were 39, 36, 61 and 64% for SVR, TVR, MIP and HR-MPR respectively. Although not significantly different from HR-MPR with respect to sensitivity (P = 0.9), MIP visualised 18% of fractures that were not reported in HR-MPR. Because of the relatively low detection rate using HR-MPRs alone, we recommend reading MIP reconstructions in addition to the obligatory HR-MPRs to improve fracture detection. (orig.)

  13. Analytical study of the artifacts appeared in the base of skull on the Artronix 1110 Neuro CAT System

    International Nuclear Information System (INIS)

    There are many kind of artifacts in the CT images of the skull base views. The streaking is one of the artifacts which radiate from the tip of sharp edged bone as pyramidal bone. But there are some different type of artifacts in the skull base region. Among these the radiated artifacts in the infratentorial region are usually demonstrated in the picture with Artronix Neuro-CT-1110. However in some pictures there are few of these artifacts. The difference of these two type of the pictures is due to the volume of air filled nasal cavity. The images which contained very small spaces of nasal cavity were looked beautiful with very few artifacts. So those artifacts might be due to the effects of the airfilled nasal cavity. The phantome was made to investigate the effects of the longitudinal distance of the airfilled cavity. The artifact begins to appear from the distance of 4 cm, and within 4 cm there are very few artifacts. The air gaps of nasopharynx and mastoid cells are all the causes of this kind of artifacts. In order to avoid these artifacts it is needed to make the adequate angle of the O-M line to eliminate the nasal cavity before taking the position for CT images. (author)

  14. Neuropsychological outcome after fractionated stereotactic radiotherapy (FSRT) for base of skull meningiomas: a prospective 1-year follow-up

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to evaluate the cognitive outcome after fractionated stereotactic radiotherapy (FSRT) in patients with base of skull meningiomas. Methods and material: A total of 40 patients with base of skull meningiomas were neuro psychologically evaluated before, after the first fraction (1.8 Gy), at the end of FSRT (n=37), 6 weeks (n=24), 6 (n=18) and 12 months (n=14) after FSRT. A comprehensive test battery including assessment of general intelligence, attention and memory functions was used. Alternate forms were used and current mood state was controlled. Results: After the first fraction a transient decline in memory function and simultaneous improvements in attention functions were observed. No cognitive deteriorations were seen during further follow-up, but increases in attention and memory functions were observed. Mood state improved after the first fraction, at the end of radiotherapy and 6 weeks after radiotherapy. Conclusion: The present data support the conclusion that the probability for the development of permanent cognitive dysfunctions appears to be very low after FSRT. The transient memory impairments on day 1 are interpreted as most likely related to an increase of a preexisting peritumoral edema, whereas the significant acute improvements in attention functions are interpreted as practice effects. An analysis of localization specific effects of radiation failed to show clear hemisphere specific cognitive changes

  15. Radiological and acetomorphine analysis of the symmetry and direction of evolution of skulls from some historic populations

    International Nuclear Information System (INIS)

    Introduction: Asymmetry is a common phenomenon in nature. It is typical for the human body and for the skull as its part. Knowledge of asymmetry and normal anatomy, especially of variability which does not represent pathology but distinguishes individuals is the basis for correct interpretation of radiological findings concerning the skull both in research and diagnostic examinations widely performed in surgery, neurology, neurosurgery, internal medicine, or pediatrics. Analysis of fluctuating asymmetry reveals the influence of stress factors on human development and the ability of the organism to defend itself against stress.The aim of this work was to analyse the asymmetry of skulls from some historic populations and to describe changes in their anatomy over the ages. Material and methods: The material consisted of three skull groups: one contemporary with 82 skulls and two mediaeval (52 skulls from Cedynia and 77 skulls from Grodek on Bug). Direct measurements were done and the skull was X-rayed in the Posterior-Anterior and skull-base projections. Images were scanned and calibrated with MicroStation 95 Academic Edition software. Helmert's transformation with first-order polynomial was done to attain a suitable geometry. Vectorisation of axes and areas was performed on reference material. Using tools for measurement of vector elements, the distance between bilateral points of both sides of the skull were obtained. Data were analysed statistically. Results: The results of measurements were used to study the directional and fluctuating asymmetry. It was found that asymmetry of the skull was present in both historic populations. The following conclusions were drawn: changes in the distribution of directional and fluctuating asymmetry for individual dimensions have taken place over the ages. A high level of directional asymmetry in the facial part and fluctuating asymmetry in the calvaria is typical for contemporary skulls. The reverse is true for relations in the

  16. Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma

    International Nuclear Information System (INIS)

    Purpose: When irradiating a tumor that abuts or displaces any normal structures, the dose constraints to those structures (if lower than the prescribed dose) may cause dose inhomogeneity in the tumor volume at the tumor-critical structure interface. The low-dose region in the tumor volume may be one of the reasons for local failure. The aim of this study is to quantitate the effect of tumor dose inhomogeneity on local control and recurrence-free survival in patients with skull base chordoma. Methods and Materials: 132 patients with skull base chordoma were treated with combined photon and proton irradiation between 1978 and 1993. This study reviews 115 patients whose dose-volume data and follow-up data are available. The prescribed doses ranged from 66.6 Cobalt-Gray-Equivalent (CGE) to 79.2 CGE (median of 68.9 CGE). The dose to the optic structures (optic nerves and chiasma), the brain stem surface, and the brain stem center was limited to 60, 64, and 53 CGE, respectively. We used the dose-volume histogram data derived with the three-dimensional treatment planning system to evaluate several dose-volume parameters including the Equivalent Uniform Dose (EUD). We also analyzed several other patient and treatment factors in relation to local control and recurrence-free survival. Results: Local failure developed in 42 of 115 patients, with the actuarial local control rates at 5 and 10 years being 59% and 44%. Gender was a significant predictor for local control with the prognosis in males being significantly better than that in females (P 0.004, hazard ratio = 2.3). In a Cox univariate analysis, with stratification by gender, the significant predictors for local control (at the probability level of 0.05) were EUD, the target volume, the minimum dose, and the D5cc dose. The prescribed dose, histology, age, the maximum dose, the mean dose, the median dose, the D90% dose, and the overall treatment time were not significant factors. In a Cox multivariate analysis, the

  17. Measure, Then Show: Grasping Human Evolution Through an Inquiry-Based, Data-driven Hominin Skulls Lab.

    Science.gov (United States)

    Bayer, Chris N; Luberda, Michael

    2016-01-01

    Incomprehension and denial of the theory of evolution among high school students has been observed to also occur when teachers are not equipped to deliver a compelling case also for human evolution based on fossil evidence. This paper assesses the outcomes of a novel inquiry-based paleoanthropology lab teaching human evolution to high-school students. The inquiry-based Be a Paleoanthropologist for a Day lab placed a dozen hominin skulls into the hands of high-school students. Upon measuring three variables of human evolution, students explain what they have observed and discuss findings. In the 2013/14 school year, 11 biology classes in 7 schools in the Greater New Orleans area participated in this lab. The interviewed teacher cohort unanimously agreed that the lab featuring hominin skull replicas and stimulating student inquiry was a pedagogically excellent method of delivering the subject of human evolution. First, the lab's learning path of transforming facts to data, information to knowledge, and knowledge to acceptance empowered students to themselves execute part of the science that underpins our understanding of deep time hominin evolution. Second, although challenging, the hands-on format of the lab was accessible to high-school students, most of whom were readily able to engage the lab's scientific process. Third, the lab's exciting and compelling pedagogy unlocked higher order thinking skills, effectively activating the cognitive, psychomotor and affected learning domains as defined in Bloom's taxonomy. Lastly, the lab afforded students a formative experience with a high degree of retention and epistemic depth. Further study is warranted to gauge the degree of these effects. PMID:27513927

  18. A dual resolution measurement based Monte Carlo simulation technique for detailed dose analysis of small volume organs in the skull base region

    Science.gov (United States)

    Yeh, Chi-Yuan; Tung, Chuan-Jung; Chao, Tsi-Chain; Lin, Mu-Han; Lee, Chung-Chi

    2014-11-01

    The purpose of this study was to examine dose distribution of a skull base tumor and surrounding critical structures in response to high dose intensity-modulated radiosurgery (IMRS) with Monte Carlo (MC) simulation using a dual resolution sandwich phantom. The measurement-based Monte Carlo (MBMC) method (Lin et al., 2009) was adopted for the study. The major components of the MBMC technique involve (1) the BEAMnrc code for beam transport through the treatment head of a Varian 21EX linear accelerator, (2) the DOSXYZnrc code for patient dose simulation and (3) an EPID-measured efficiency map which describes non-uniform fluence distribution of the IMRS treatment beam. For the simulated case, five isocentric 6 MV photon beams were designed to deliver a total dose of 1200 cGy in two fractions to the skull base tumor. A sandwich phantom for the MBMC simulation was created based on the patient's CT scan of a skull base tumor [gross tumor volume (GTV)=8.4 cm3] near the right 8th cranial nerve. The phantom, consisted of a 1.2-cm thick skull base region, had a voxel resolution of 0.05×0.05×0.1 cm3 and was sandwiched in between 0.05×0.05×0.3 cm3 slices of a head phantom. A coarser 0.2×0.2×0.3 cm3 single resolution (SR) phantom was also created for comparison with the sandwich phantom. A particle history of 3×108 for each beam was used for simulations of both the SR and the sandwich phantoms to achieve a statistical uncertainty of <2%. Our study showed that the planning target volume (PTV) receiving at least 95% of the prescribed dose (VPTV95) was 96.9%, 96.7% and 99.9% for the TPS, SR, and sandwich phantom, respectively. The maximum and mean doses to large organs such as the PTV, brain stem, and parotid gland for the TPS, SR and sandwich MC simulations did not show any significant difference; however, significant dose differences were observed for very small structures like the right 8th cranial nerve, right cochlea, right malleus and right semicircular canal. Dose

  19. A Bullet Entered through the Open Mouth and Ended Up in the Parapharyngeal Space and Skull Base

    Directory of Open Access Journals (Sweden)

    Saileswar Goswami

    2015-01-01

    Full Text Available Shot from a revolver from a close range, a bullet pierced the chest of a policeman and entered through the open mouth of a young male person standing behind. The entry wound was found in the cheek mucosa adjacent to the left lower third molar. After hitting and fracturing the body and the ramus of the mandible, the bullet was deflected and was finally lodged in the parapharyngeal space and skull base, anterolateral to the transverse process of the atlas. The great vessels of the neck were not injured. The patient’s condition was very critical but his life could be saved. The bullet was approached through a modified Blair’s incision and was found to be lying over the carotid sheath. It was removed safely and the patient recovered completely.

  20. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors.

    Science.gov (United States)

    Graffeo, Christopher S; Dietrich, August R; Grobelny, Bartosz; Zhang, Meng; Goldberg, Judith D; Golfinos, John G; Lebowitz, Richard; Kleinberg, David; Placantonakis, Dimitris G

    2014-08-01

    Endoscopic endonasal surgery has been established as the safest approach to pituitary tumors, yet its role in other common skull base lesions has not been established. To answer this question, we carried out a systematic review of reported series of open and endoscopic endonasal approaches to four major skull base tumors: olfactory groove meningiomas (OGM), tuberculum sellae meningiomas (TSM), craniopharyngiomas (CRA), and clival chordomas (CHO). Data from 162 studies containing 5,701 patients were combined and compared for differences in perioperative mortality, gross total resection (GTR), cerebrospinal fluid (CSF) leak, neurological morbidity, post-operative visual function, post-operative anosmia, post-operative diabetes insipidus (DI), and post-operative obesity/hyperphagia. Weighted average rates for each outcome were calculated using relative study size. Our findings indicate similar rates of GTR and perioperative mortality between open and endoscopic approaches for all tumor types. CSF leak was increased after endoscopic surgery. Visual function symptoms were more likely to improve after endoscopic surgery for TSM, CRA, and CHO. Post-operative DI and obesity/hyperphagia were significantly increased after open resection in CRA. Recurrence rates per 1,000 patient-years of follow-up were higher in endoscopy for OGM, TSM, and CHO. Trends for open and endoscopic surgery suggested modest improvement in all outcomes over time. Our observations suggest that endonasal endoscopy is a safe alternative to craniotomy and may be preferred for certain tumor types. However, endoscopic surgery is associated with higher rates of CSF leak, and possibly increased recurrence rates. Prospective study with long-term follow-up is required to verify these preliminary observations. PMID:24014055

  1. NUMERICAL SIMULATION OF INDUCTION SKULL MELTING PROCESS FOR TITANIUM-ALUMINIUM BASE ALLOY

    Institute of Scientific and Technical Information of China (English)

    Z.Y. Chen; L.J. Xu; F.T. Kong; Q. Shu; Y.Y. Chen

    2004-01-01

    The mathematics model for temperature field of water-cooling copper crucible induction skull melting process was established. The program for simulating temperature field of melting process was developed with finite element method. The temperature field of the melting process for Ti-47Al-2Cr-2Nb alloy was calculated. During melting period, the temperature is raised gradually along radius augmentation direction. The elements of the charge near the crucible wall are molten first. The center elements of the charge are molten last. The melting time of the center element is just that of all the charge melting. The melting time of Ti-47Al-2Cr-2Nb alloy is 15min. In which, the charge was heated by low power 80kW for 9min and by high power 300kW for 6min. When melting Ti-47Al-2Cr-2Nb alloy,the loading power is nearly direct proportion to melt temperature. Increasing loading power may raise melt temperature. The best melting power of Ti-47Al-2Cr-2Nb alloy is 305-310kW. This is identical with the melting test and has guidance sense to the melting process of actual titanium alloy.

  2. Detecting plasma Epstein-Barr virus DNA to diagnose postradiation nasopharyngeal skull base lesions in nasopharyngeal carcinoma patients: a prospective study

    Institute of Scientific and Technical Information of China (English)

    Fa-Ya Liang; Wei Sun; Ping Han; Xing Lu; Ying-Ni Lian; Xiao-Ming Huang

    2012-01-01

    The diagnosis of postradiation nasopharyngeal skull base lesions in petients with nasopharyngeal carcinoma (NPC) is still a tough problem in clinical practice.An early and accurate diagnosis is important for subsequent management.We prospectively evaluated the diagnostic value of plasma Epstein-Barr virus (EBV) DNA in detecting postradiation nasopharyngeal skull base lesions in NPC patients.From July 2006 to September 2010,90 patients with postradiation NPC (34 women and 56 men; median age:42years) met the selection criteria and were recruited in this study.All postradiation nasopharyngeal skull base lesions were found in the latest magnetic resonance imaging (MRI) examinations before endoscopic surgery,and the nasopharyngeal cavity was normal under flexible nasopharyngoscopy.Plasma EBV DNA detection was performed within 2 weeks before endoscopic surgery.A total of 90 endoscopic operations were successfully performed without any postoperative complications. Recurrences confirmed by postoperative pathology were found in 30 patients.The specificity,positive and negative predictive values of plasma EBV DNA detection were better than those of MRI.In addition,combining plasma EBV DNA detection with MRI improved the specificity and positive predictive values of MRI.Plasma EBV DNA detection followed by MRI would help to diagnose recurrence whereas MRI was unable.These results indicate that plasma EBV DNA is an effective and feasible biomarker for detecting postradiation nasopharyngeal skull base lesions in NPC patients.

  3. Electrophysiological Monitoring in Patients With Tumors of the Skull Base Treated by Carbon-12 Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Carozzo, Simone [Department of Neuroscience, Ophthalmology, and Genetics, University of Genova, Genova (Italy); Schardt, Dieter [Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt (Germany); Narici, Livio [Department of Physics, University of Rome Tor Vergata, Rome (Italy); Combs, Stephanie E.; Debus, Jürgen [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Sannita, Walter G., E-mail: wgs@dism.unige.it [Department of Neuroscience, Ophthalmology, and Genetics, University of Genova, Genova (Italy); Department of Psychiatry, State University of New York, Stony Brook, New York (United States)

    2013-03-15

    Purpose: To report the results of short-term electrophysiologic monitoring of patients undergoing {sup 12}C therapy for the treatment of skull chordomas and chondrosarcomas unsuitable for radical surgery. Methods and Materials: Conventional electroencephalogram (EEG) and retinal and cortical electrophysiologic responses to contrast stimuli were recorded from 30 patients undergoing carbon ion radiation therapy, within a few hours before the first treatment and after completion of therapy. Methodologies and procedures were compliant with the guidelines of the International Federation for Clinical Neurophysiology and International Society for Clinical Electrophysiology of Vision. Results: At baseline, clinical signs were reported in 56.6% of subjects. Electrophysiologic test results were abnormal in 76.7% (EEG), 78.6% (cortical evoked potentials), and 92.8% (electroretinogram) of cases, without correlation with neurologic signs, tumor location, or therapy plan. Results on EEG, but not electroretinograms and cortical responses, were more often abnormal in patients with reported clinical signs. Abnormal EEG results and retinal/cortical responses improved after therapy in 40% (EEG), 62.5% (cortical potentials), and 70% (electroretinogram) of cases. Results on EEG worsened after therapy in one-third of patients whose recordings were normal at baseline. Conclusions: The percentages of subjects whose EEG results improved or worsened after therapy and the improvement of retinal/cortical responses in the majority of patients are indicative of a limited or negligible (and possibly transient) acute central nervous system toxicity of carbon ion therapy, with a significant beneficial effect on the visual pathways. Research on large samples would validate electrophysiologic procedures as a possible independent test for central nervous system toxicity and allow investigation of the correlation with clinical signs; repeated testing over time after therapy would demonstrate, and may

  4. Randomised trial of proton vs. carbon ion radiation therapy in patients with chordoma of the skull base, clinical phase III study HIT-1-Study

    International Nuclear Information System (INIS)

    Chordomas of the skull base are relative rare lesions of the bones. Surgical resection is the primary treatment standard, though complete resection is nearly impossible due to close proximity to critical and hence also dose limiting organs for radiation therapy. Level of recurrence after surgery alone is comparatively high, so adjuvant radiation therapy is very important for the improvement of local control rates. Proton therapy is the gold standard in the treatment of skull base chordomas. However, high-LET beams such as carbon ions theoretically offer biologic advantages by enhanced biologic effectiveness in slow-growing tumors. This clinical study is a prospective randomised phase III trial. The trial will be carried out at Heidelberger Ionenstrahl-Therapie centre (HIT) and is a monocentric study. Patients with skull base chordoma will be randomised to either proton or carbon ion radiation therapy. As a standard, patients will undergo non-invasive, rigid immobilization and target volume delineation will be carried out based on CT and MRI data. The biologically isoeffective target dose to the PTV in carbon ion treatment (accelerated dose) will be 63 Gy E ± 5% and 72 Gy E ± 5% (standard dose) in proton therapy respectively. Local-progression free survival (LPFS) will be analysed as primary end point. Toxicity and overall survival are the secondary end points. Additional examined parameters are patterns of recurrence, prognostic factors and plan quality analysis. Up until now it was impossible to compare two different particle therapies, i.e. protons and carbon ions directly at the same facility. The aim of this study is to find out, whether the biological advantages of carbon ion therapy can also be clinically confirmed and translated into the better local control rates in the treatment of skull base chordomas. ClinicalTrials.gov identifier: NCT01182779

  5. A dual resolution measurement based Monte Carlo simulation technique for detailed dose analysis of small volume organs in the skull base region

    International Nuclear Information System (INIS)

    The purpose of this study was to examine dose distribution of a skull base tumor and surrounding critical structures in response to high dose intensity-modulated radiosurgery (IMRS) with Monte Carlo (MC) simulation using a dual resolution sandwich phantom. The measurement-based Monte Carlo (MBMC) method (Lin et al., 2009) was adopted for the study. The major components of the MBMC technique involve (1) the BEAMnrc code for beam transport through the treatment head of a Varian 21EX linear accelerator, (2) the DOSXYZnrc code for patient dose simulation and (3) an EPID-measured efficiency map which describes non-uniform fluence distribution of the IMRS treatment beam. For the simulated case, five isocentric 6 MV photon beams were designed to deliver a total dose of 1200 cGy in two fractions to the skull base tumor. A sandwich phantom for the MBMC simulation was created based on the patient's CT scan of a skull base tumor [gross tumor volume (GTV)=8.4 cm3] near the right 8th cranial nerve. The phantom, consisted of a 1.2-cm thick skull base region, had a voxel resolution of 0.05×0.05×0.1 cm3 and was sandwiched in between 0.05×0.05×0.3 cm3 slices of a head phantom. A coarser 0.2×0.2×0.3 cm3 single resolution (SR) phantom was also created for comparison with the sandwich phantom. A particle history of 3×108 for each beam was used for simulations of both the SR and the sandwich phantoms to achieve a statistical uncertainty of <2%. Our study showed that the planning target volume (PTV) receiving at least 95% of the prescribed dose (VPTV95) was 96.9%, 96.7% and 99.9% for the TPS, SR, and sandwich phantom, respectively. The maximum and mean doses to large organs such as the PTV, brain stem, and parotid gland for the TPS, SR and sandwich MC simulations did not show any significant difference; however, significant dose differences were observed for very small structures like the right 8th cranial nerve, right cochlea, right malleus and right semicircular canal

  6. Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudo-continuous arterial spin labeling images

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Tatsuya, E-mail: yamatatu_01eik@yahoo.co.jp [Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui (Japan); Takeuchi, Hiroaki, E-mail: takeu@u-fukui.ac.jp [Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui (Japan); Kinoshita, Kazuyuki, E-mail: kkino@u-fukui.ac.jp [Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui (Japan); Kosaka, Nobuyuki, E-mail: nkosaka@u-fukui.ac.jp [Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui (Japan); Kimura, Hirohiko, E-mail: kimura@u-fukui.ac.jp [Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui (Japan)

    2014-05-15

    Objective: We aimed to investigate whether pseudo-continuous arterial spin labeling (pcASL)-MRI can adequately evaluate tumor perfusion even if the tumors are located in the skull base region and evaluate the correlation between tumor blood flow (TBF) and the histopathologic features of skull base meningiomas and schwannomas. Materials and methods: We enrolled 31 patients with skull base meningioma (n = 14) and schwannoma (n = 17) who underwent surgical resection. TBF was calculated from pcASL. Tissue sections were stained with CD34 to evaluate microvessel area (MVA). TBF and MVA ratio were compared between meningiomas and schwannomas using Mann–Whitney U-test. The correlations between MVA ratio and TBF were evaluated in each tumor by using single linear regression analysis and Spearman's rank correlation coefficients (r{sub s}). Results: MVA ratio and TBF were significantly higher in meningioma than in schwannoma (both p < 0.01). Correlation analyses revealed significant positive correlations between MVA ratio and both mean and max TBF for meningiomas (r{sub s} = 0.89, 0.81, both p < 0.01). There was a weak positive correlation between MVA ratio and mean TBF for schwannomas (r{sub s} = 0.43, p = 0.04). However, no significant correlation was found between MVA ratio and max TBF for schwannoma. Conclusions: pcASL-MRI is useful for evaluating tumor perfusion even if the tumors are located in the skull base region. Moreover, pcASL-TBF was significantly higher in most meningiomas compared to schwannomas, which can help in the differential diagnosis of the 2 tumor types even without the use of contrast material.

  7. Fractionated stereotactic radiotherapy of benign skull-base tumors: a dosimetric comparison of volumetric modulated arc therapy with Rapidarc® versus non-coplanar dynamic arcs

    OpenAIRE

    Martin, Fanny; Magnier, Florian; Berger, Lucie; Miroir, Jessica; Chautard, Emmanuel; Verrelle, Pierre; Lapeyre, Michel; Biau, Julian

    2016-01-01

    Background Benign tumors of the skull base are a challenge when delivering radiotherapy. An appropriate choice of radiation technique may significantly improve the patient’s outcomes. Our study aimed to compare the dosimetric results of fractionated stereotactic radiotherapy between non-coplanar dynamic arcs and coplanar volumetric modulated arctherapy (Rapidarc®). Methods Thirteen patients treated with Novalis TX® were analysed: six vestibular schwannomas, four pituitary adenomas and three m...

  8. CT and MRI of intrinsic space-occupying lesions of the bony skull base; CT und MRT bei intrinsischen raumfordernden Laesionen der knoechernen Schaedelbasis

    Energy Technology Data Exchange (ETDEWEB)

    Koesling, S.; Brandt, S. [Martin-Luther-Universitaet Halle-Wittenberg, Universitaetsklinik und Poliklinik fuer Diagnostische Radiologie, Halle (Germany); Neumann, K. [Martin-Luther-Universitaet Halle-Wittenberg, Universitaetsklinik und Poliklinik fuer Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Halle (Germany)

    2009-07-15

    Intrinsic bony lesions of the skull base are diseases which arise within the bones forming the skull base. Mainly they are bone tumours and tumour-like lesions. With the exception of osteomas of the paranasal sinuses and exostoses of the external auditory canal, these lesions occur rarely. This article gives an overview of the appearance of the most common primary bony skull base masses in CT and MRI. From the authors' point of view these are fibrous dysplasia, chordomas, chondrosarcomas, Langerhans cell histiocytosis and multiple myelomas, which must be differentiated from pseudolesions. The possibilities of CT and MRI in making a specific diagnosis, differential diagnosis and the kind of making the final diagnosis are described. (orig.) [German] Unter intrinsischen Laesionen der knoechernen Schaedelbasis versteht man Erkrankungen, die von den die Schaedelbasis bildenden Knochen ausgehen. In erster Linie handelt es sich um Knochentumoren und tumoraehnliche Laesionen. Mit wenigen Ausnahmen (Nasennebenhoehlenosteome, Exostosen des aeusseren Gehoergangs) sind sie selten. Dieser Beitrag gibt einen Ueberblick ueber das CT- und MRT-Erscheinungsbild der aus Sicht der Autoren unter diesem Aspekt noch am haeufigsten anzutreffenden raumfordernden Laesionen. Dazu zaehlen die fibroese Dysplasie, Chordome, Chondrosarkome, die Langerhans-Zell-Histiozytose und das multiple Myelom. Abgrenzt werden muessen Pseudotumoren. Artdiagnostische Zuordnungsmoeglichkeiten durch CT und/oder MRT, Differenzialdiagnosen und Diagnosesicherung werden dargelegt. (orig.)

  9. Comparison of intensity modulated radiotherapy (IMRT) with intensity modulated particle therapy (IMPT) using fixed beams or an ion gantry for the treatment of patients with skull base meningiomas

    International Nuclear Information System (INIS)

    To examine the potential improvement in treatment planning for patients with skull base meningioma using IMRT compared to carbon ion or proton beams with and without a gantry. Five patients originally treated with photon IMRT were selected for the study. Ion beams were chosen using a horizontal beam or an ion gantry. Intensity controlled raster scanning and the intensity modulated particle therapy mode were used for plan optimization. The evaluation included analysis of dose-volume histograms of the target volumes and organs at risk. In comparison with carbon and proton beams only with horizontal beams, carbon ion treatment plans could spare the OARs more and concentrated on the target volumes more than proton and photon IMRT treatment plans. Using only a horizontal fixed beam, satisfactory plans could be achieved for skull base tumors. The results of the case studies showed that using IMPT has the potential to overcome the lack of a gantry for skull base tumors. Carbon ion plans offered slightly better dose distributions than proton plans, but the differences were not clinically significant with established dose prescription concepts

  10. Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy

    International Nuclear Information System (INIS)

    Skull base osteomyelitis (SBO) refers to infection that has spread beyond the external auditory canal to the base of the skull in advanced stages of otitis externa. Clinically, it may be difficult to differentiate SBO from severe otitis externa without bony involvement. This study was performed to determine the role of three phase bone scintigraphy (TPBS) and single photon emission tomography/computed tomography (SPECT/CT) in detecting SBO. We retrospectively analyzed records of 20 patients (14 M, 6 F) with otitis externa and suspected SBO. TPBS and SPECT/CT of the skull were performed. Findings were correlated with clinical, laboratory and diagnostic CT scan findings. All patients were diabetic with elevated erythrocyte sedimentation rate. A total of 18 patients had bilateral and two unilateral symptoms. Cranial nerves were involved in eight patients and microbiological culture of ear discharge fluid positive in seven. Early images showed increased temporal vascularity in nine patients and increased soft-tissue uptake in 10, while delayed images showed increased bone uptake in 19/20 patients. Localized abnormal tracer uptake was shown by SPECT/CT in the mastoid temporal (15), petrous (11), sphenoid (3) and zygomatic (1) and showed destructive changes in five. Thus, TPBS was found positive for SBO in 10/20 patients and changed the management in four. Our study suggests that TPBS with SPECT/CT is a useful non-invasive investigation for detection of SBO in otitis externa

  11. Randomised trial of proton vs. carbon ion radiation therapy in patients with low and intermediate grade chondrosarcoma of the skull base, clinical phase III study

    Directory of Open Access Journals (Sweden)

    Combs Stephanie E

    2010-11-01

    Full Text Available Background Low and intermediate grade chondrosarcomas are relative rare bone tumours. About 5-12% of all chondrosarcomas are localized in base of skull region. Low grade chondrosarcoma has a low incidence of distant metastasis but is potentially lethal disease. Therefore, local therapy is of crucial importance in the treatment of skull base chondrosarcomas. Surgical resection is the primary treatment standard. Unfortunately the late diagnosis and diagnosis at the extensive stage are common due to the slow and asymptomatic growth of the lesions. Consequently, complete resection is hindered due to close proximity to critical and hence dose limiting organs such as optic nerves, chiasm and brainstem. Adjuvant or additional radiation therapy is very important for the improvement of local control rates in the primary treatment. Proton therapy is the gold standard in the treatment of skull base chondrosarcomas. However, high-LET (linear energy transfer beams such as carbon ions theoretically offer advantages by enhanced biologic effectiveness in slow-growing tumours. Methods/Design The study is a prospective randomised active-controlled clinical phase III trial. The trial will be carried out at Heidelberger Ionenstrahl-Therapie (HIT centre as monocentric trial. Patients with skull base chondrosarcomas will be randomised to either proton or carbon ion radiation therapy. As a standard, patients will undergo non-invasive, rigid immobilization and target volume definition will be carried out based on CT and MRI data. The biologically isoeffective target dose to the PTV (planning target volume in carbon ion treatment will be 60 Gy E ± 5% and 70 Gy E ± 5% (standard dose in proton therapy respectively. The 5 year local-progression free survival (LPFS rate will be analysed as primary end point. Overall survival, progression free and metastasis free survival, patterns of recurrence, local control rate and morbidity are the secondary end points. Discussion Up

  12. Randomised trial of proton vs. carbon ion radiation therapy in patients with low and intermediate grade chondrosarcoma of the skull base, clinical phase III study

    International Nuclear Information System (INIS)

    Low and intermediate grade chondrosarcomas are relative rare bone tumours. About 5-12% of all chondrosarcomas are localized in base of skull region. Low grade chondrosarcoma has a low incidence of distant metastasis but is potentially lethal disease. Therefore, local therapy is of crucial importance in the treatment of skull base chondrosarcomas. Surgical resection is the primary treatment standard. Unfortunately the late diagnosis and diagnosis at the extensive stage are common due to the slow and asymptomatic growth of the lesions. Consequently, complete resection is hindered due to close proximity to critical and hence dose limiting organs such as optic nerves, chiasm and brainstem. Adjuvant or additional radiation therapy is very important for the improvement of local control rates in the primary treatment. Proton therapy is the gold standard in the treatment of skull base chondrosarcomas. However, high-LET (linear energy transfer) beams such as carbon ions theoretically offer advantages by enhanced biologic effectiveness in slow-growing tumours. The study is a prospective randomised active-controlled clinical phase III trial. The trial will be carried out at Heidelberger Ionenstrahl-Therapie (HIT) centre as monocentric trial. Patients with skull base chondrosarcomas will be randomised to either proton or carbon ion radiation therapy. As a standard, patients will undergo non-invasive, rigid immobilization and target volume definition will be carried out based on CT and MRI data. The biologically isoeffective target dose to the PTV (planning target volume) in carbon ion treatment will be 60 Gy E ± 5% and 70 Gy E ± 5% (standard dose) in proton therapy respectively. The 5 year local-progression free survival (LPFS) rate will be analysed as primary end point. Overall survival, progression free and metastasis free survival, patterns of recurrence, local control rate and morbidity are the secondary end points. Up to now it was impossible to compare two different

  13. MRI-detected skull-base invasion. Prognostic value and therapeutic implication in intensity-modulated radiotherapy treatment for nasopharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Yi-Kan; Jiang, Ning; Yue, Dan; Tang, Ling-Long; Zhang, Fan; Lin, Li; Liu, Xu; Chen, Lei; Ma, Jun [Sun Yat-sen University Cancer Center, Department of Radiation Oncology, Guangzhou (China); Liu, Li-Zhi [Sun Yat-sen University Cancer Center, Department of Radiology, Guangzhou (China)

    2014-10-15

    With advances in imaging and radiotherapy, the prognostic value of skull-base invasion in nasopharyngeal carcinoma (NPC) needs to be reassessed. We aimed to define a classification system and evaluate the prognostic value of the classification of magnetic resonance imaging (MRI)-detected skull-base invasion in NPC treated with intensity-modulated radiotherapy (IMRT). We retrospectively reviewed 749 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated NPC and treated with IMRT. MRI-detected skull-base invasion was not found to be an independent prognostic factor for overall survival (OS), distant metastasis-free survival (DMFS), local relapse-free survival (LRFS), or disease-free survival (DFS; p > 0.05 for all). Skull-base invasion was classified according to the incidence of each site (type I sites inside pharyngobasilar fascia and clivus vs. type II sites outside pharyngobasilar fascia). The 5-year OS, DMFS, LRFS, and DFS rates in the classification of skull-base invasion in NPC were 83 vs. 67 %, 85 vs.75 %, 95 vs. 88 %, and 76 vs. 62 %, respectively (p < 0.05 for all). Multivariate analysis indicated the classification of skull-base invasion was an independent prognostic factor. MRI-detected skull-base invasion is not an independent prognostic factor in patients with NPC treated with IMRT. However, classification according to the site of invasion has prognostic value. Therefore, patients with various subclassifications of stage T3 disease may receive treatment with different intensities; however, further studies are warranted to prove this. (orig.) [German] Aufgrund der Fortschritte der bildgebenden Verfahren und der Strahlentherapie muss der prognostische Wert der Invasion des nasopharyngealen Karzinoms (NPC) in die Schaedelbasis erneut bewertet werden. Unser Ziel ist die Definition eines Klassifikationssystems und die Untersuchung des prognostischen Werts der Klassifikation der MRT-ermittelten Invasion des mit

  14. Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective Study

    OpenAIRE

    El Shazly, Mohamed A.; Mahmoud A.M. Mokbel; Amr A. Elbadry; Hatem S. Badran

    2011-01-01

    Background: Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative li...

  15. Skull Base Clear Cell Carcinoma, Metastasis of Renal Primary Tumor: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ilson Sepúlveda

    2013-08-01

    Full Text Available We report on a patient who presented with cranial nerve VI bilateral paresis, absence of pharyngeal reflex, dysarthria, right tongue deviation, and right facial paralysis. Imaging studies showed an expansive process in the cranial base with clivus and petrous apex osteolysis. A biopsy confirmed the presence of clear cell adenocarcinoma and suspicion of renal tumor metastases. Abdominal imaging studies revealed a mass in the right kidney. Consequently, radiotherapy was performed, and the patient was enrolled in a palliative care and pain control program.

  16. Spot Scanning Proton Therapy for Malignancies of the Base of Skull: Treatment Planning, Acute Toxicities, and Preliminary Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Grosshans, David R., E-mail: dgrossha@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhu, X. Ronald; Melancon, Adam [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Allen, Pamela K. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk; Palmer, Matthew [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); McAleer, Mary Frances; McGovern, Susan L. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gillin, Michael [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); DeMonte, Franco [Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California (United States); Brown, Paul D.; Mahajan, Anita [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-11-01

    Purpose: To describe treatment planning techniques and early clinical outcomes in patients treated with spot scanning proton therapy for chordoma or chondrosarcoma of the skull base. Methods and Materials: From June 2010 through August 2011, 15 patients were treated with spot scanning proton therapy for chordoma (n=10) or chondrosarcoma (n=5) at a single institution. Toxicity was prospectively evaluated and scored weekly and at all follow-up visits according to Common Terminology Criteria for Adverse Events, version 3.0. Treatment planning techniques and dosimetric data were recorded and compared with those of passive scattering plans created with clinically applicable dose constraints. Results: Ten patients were treated with single-field-optimized scanning beam plans and 5 with multifield-optimized intensity modulated proton therapy. All but 2 patients received a simultaneous integrated boost as well. The mean prescribed radiation doses were 69.8 Gy (relative biological effectiveness [RBE]; range, 68-70 Gy [RBE]) for chordoma and 68.4 Gy (RBE) (range, 66-70) for chondrosarcoma. In comparison with passive scattering plans, spot scanning plans demonstrated improved high-dose conformality and sparing of temporal lobes and brainstem. Clinically, the most common acute toxicities included fatigue (grade 2 for 2 patients, grade 1 for 8 patients) and nausea (grade 2 for 2 patients, grade 1 for 6 patients). No toxicities of grades 3 to 5 were recorded. At a median follow-up time of 27 months (range, 13-42 months), 1 patient had experienced local recurrence and a second developed distant metastatic disease. Two patients had magnetic resonance imaging-documented temporal lobe changes, and a third patient developed facial numbness. No other subacute or late effects were recorded. Conclusions: In comparison to passive scattering, treatment plans for spot scanning proton therapy displayed improved high-dose conformality. Clinically, the treatment was well tolerated, and

  17. Adaptation of proton total dose with respect to dosimetric parameters within the frame of treatment of skull base or upper cervical spine chordomas

    International Nuclear Information System (INIS)

    The authors report the study of the feasibility of a photon-proton irradiation protocol with a dose adaptation with respect to dosimetric factors for patients suffering form a skull base and upper cervical spine chordoma. Sixty patients have been treated between May 2006 and June 2008 with a combination of high energy photons and protons. As five tumours have locally relapsed and one at distance, the authors comment the local control rates, the number of attained cranial nerves, the value of the macroscopic tumour volume, the survival rate without relapse in terms of multifactorial of uni-factorial analysis. Short communication

  18. Aspects of achondroplasia in the skulls of dwarf transgenic mice: a cephalometric study.

    Science.gov (United States)

    Bloom, Melissa Wadler; Murakami, Shunichi; Cody, Dianna; Montufar-Solis, Dina; Duke, Pauline Jackie

    2006-03-01

    Achondroplasia, the most common short-limbed dwarfism in humans, results from a single nucleotide substitution in the gene for fibroblast growth factor receptor 3 (FGFR3). FGFR3 regulates bone growth in part via the mitogen-activated protein kinase pathway (MAPK). To examine the role of this pathway in chondrocyte differentiation, a transgenic mouse was generated that expresses a constitutively active mutant of MEK1 in chondrocytes and exhibits dwarfing characteristics typical of human achondroplasia, i.e., shortened axial and appendicular skeletons, mid-facial hypoplasia, and dome-shaped cranium. In this study, cephalometrics of the MEK1 mutant skulls were assessed to determine if the MEK1 mice are a good model of achondroplasia. Skull length, arc of the cranial vault, and area, maximum and minimum diameters of the brain case were measured on digitized radiographs of skulls of MEK1 and control mice. Cranial base and nasal bone length and foramen magnum diameter were measured on midsagittal micro-CT sections. Data were normalized by dividing by the cube root of each animal's weight. Transgenic mice exhibited a domed skull, deficient midface, and (relatively) prognathic mandible and had a shorter cranial base and nasal bone than the wild-type. Skull length was significantly less in transgenic mice, but cranial arc was significantly greater. The brain case was larger and more circular and minimum diameter of the brain case was significantly greater in transgenic mice. The foramen magnum was displaced anteriorly but not narrowed. MEK1 mouse cephalometrics confirm these mice as a model for achondroplasia, demonstrating that the MAP kinase signaling pathway is involved in FGF signaling in skeletal development. PMID:16463380

  19. The ''lamellar skull''

    International Nuclear Information System (INIS)

    The skull in homozygous β-thalassemia (Cooley's anemia) may present with several abnormalities, such as osteopenia, widening of the diploic space, and a ''hair on end'' appearance. In some cases it present also a paticular stratified aspect owing to a variable number of osseous lamellae, arranged so as to be parallel to the inner table. This ''lamelled skull'' was observed in 16 patients, selected from 150 patients with Cooley's anemia (10.6%). The possible mechanisms are discussed. The pluristratified lamellar osseous production could be brought about by repeated periosteal osteoblastic reaction to the sinusoidal neovascularization associated with marrow hyperplasia in poorly or not at all transfused patients

  20. Interparietal bones in Nigerian skulls.

    OpenAIRE

    Saxena, S. K.; Chowdhary, D S; Jain, S P

    1986-01-01

    The study was conducted on 40 adult Nigerian skulls which were examined for the presence of interparietal and pre-interparietal bones. Only one interparietal bone was found (2.5% of the present series) while a single pre-interparietal bone was found in four skulls (10%) and multiple pre-interparietal bones in one skull (2.5%).

  1. MSCT versus CBCT: evaluation of high-resolution acquisition modes for dento-maxillary and skull-base imaging

    Energy Technology Data Exchange (ETDEWEB)

    Dillenseger, Jean-Philippe; Goetz, Christian [Hopitaux Universitaires de Strasbourg, Imagerie Preclinique-UF6237, Pole d' imagerie, Strasbourg (France); Universite de Strasbourg, Icube, equipe MMB, CNRS, Strasbourg (France); Universite de Strasbourg, Federation de Medecine Translationnelle de Strasbourg, Faculte de Medecine, Strasbourg (France); Matern, Jean-Francois [Hopitaux Universitaires de Strasbourg, Imagerie Preclinique-UF6237, Pole d' imagerie, Strasbourg (France); Universite de Strasbourg, Federation de Medecine Translationnelle de Strasbourg, Faculte de Medecine, Strasbourg (France); Gros, Catherine-Isabelle; Bornert, Fabien [Universite de Strasbourg, Federation de Medecine Translationnelle de Strasbourg, Faculte de Medecine, Strasbourg (France); Universite de Strasbourg, Faculte de Chirurgie Dentaire, Strasbourg (France); Le Minor, Jean-Marie [Universite de Strasbourg, Icube, equipe MMB, CNRS, Strasbourg (France); Universite de Strasbourg, Federation de Medecine Translationnelle de Strasbourg, Faculte de Medecine, Strasbourg (France); Universite de Strasbourg, Institut d' Anatomie Normale, Strasbourg (France); Constantinesco, Andre [Hopitaux Universitaires de Strasbourg, Imagerie Preclinique-UF6237, Pole d' imagerie, Strasbourg (France); Choquet, Philippe [Hopitaux Universitaires de Strasbourg, Imagerie Preclinique-UF6237, Pole d' imagerie, Strasbourg (France); Universite de Strasbourg, Icube, equipe MMB, CNRS, Strasbourg (France); Universite de Strasbourg, Federation de Medecine Translationnelle de Strasbourg, Faculte de Medecine, Strasbourg (France); Hopital de Hautepierre, Imagerie Preclinique, Biophysique et Medecine Nucleaire, Strasbourg Cedex (France)

    2014-09-24

    Our aim was to conduct a quantitative and qualitative evaluation of high-resolution skull-bone imaging for dentistry and otolaryngology using different architectures of recent X-ray computed tomography systems. Three multi-slice computed tomography (MSCT) systems and one Cone-beam computed tomography (CBCT) system were used in this study. All apparatuses were tested with installed acquisition modes and proprietary reconstruction software enabling high-resolution bone imaging. Quantitative analyses were performed with small fields of view with the preclinical vmCT phantom, which permits to measure spatial resolution, geometrical accuracy, linearity and homogeneity. Ten operators performed visual qualitative analyses on the vmCT phantom images, and on dry human skull images. Quantitative analysis showed no significant differences between protocols in terms of linearity and geometric accuracy. All MSCT systems present a better homogeneity than the CBCT. Both quantitative and visual analyses demonstrate that CBCT acquisitions are not better than the collimated helical MSCT mode. Our results demonstrate that current high-resolution MSCT protocols could exceed the performance of a previous generation CBCT system for spatial resolution and image homogeneity. (orig.)

  2. Morphometric Analysis of Bone Resection in Anterior Petrosectomies.

    Science.gov (United States)

    Ahmed, Osama; Walther, Jonathan; Theriot, Krystle; Manuel, Morganne; Guthikonda, Bharat

    2016-06-01

    Introduction The anterior petrosectomy is a well-defined skull base approach to lesions such as petroclival meningiomas, posterior circulation aneurysms, petrous apex lesions (chondrosarcomas, cholesteatomas), ventrolateral brainstem lesions, clival chordomas, trigeminal neurinomas, and access to cranial nerves III, IV, V, and VII. Methods and Materials Fourteen anterior petrosectomies on eight cadaveric heads were performed in a skull base dissection laboratory. Predissection and postdissection thin-cut computed tomography scans were obtained to compare the bone resection. A computer program was used (InVivo5, Anatomage, San Jose, California, United States) to measure the bone resection and the improved viewing angle. Results The average bone removed in each plane was as follows: anterior to posterior plane was 10.57 mm ± 2.00 mm, superior to inferior was 9.39 mm ± 1.67 mm, and lateral to medial was 17.46 mm ± 4.64 mm. The average increased angle of view was 13.01 ± 2.35 degrees (Table 1). The average volume was 1786.94 ± 827.40 mm(3). Conclusions Anterior petrosectomy is a useful approach to access the ventrolateral brainstem region. We present a cadaveric study quantitating the volume of bone resection and improvement in the viewing angle. These data provide useful preoperative information on the utility of this skull base approach and the gain in the viewing angle after bony removal. PMID:27175319

  3. Neurosurgical considerations of cranial base surgery.

    Science.gov (United States)

    Chenelle, A G; Shaffrey, M E; Delashaw, J B; Jane, J A

    1995-07-01

    Several craniotomies have been described that allow extensive resection of skull base and low-lying cranial tumors that involve little disfigurement to the patient. These techniques should be of interest to plastic surgeons as they may be called to aid their neurosurgical colleagues in exposing the anterior skull base or may be involved in combined procedures to resect tumors that involve the face, sinuses, orbit, and cranial vault. PMID:7554716

  4. Functional structure of the skull in hominoidea.

    Science.gov (United States)

    Preuschoft, H; Witzel, U

    2004-01-01

    Finite elements stress analysis (FESA) was used to investigate the flow of compressive forces which occur if a homogenous, three-dimensional body representing the skull is loaded by simulated bite forces against the tooth row. Model 1 represents the snout alone. Bite forces are applied simultaneously, but increase rearward. Stresses in the model concentrate along the anterior contour and the lower surface of the model, leaving unstressed a nasal opening and a wide naso-oral connection. Model 2 represents the facial region, as far as the temporomandibular joint. The orbits and the nasal cavity are assumed to be present a priori. Model 3 applies reactions to the bite forces in the temporal fossa, corresponding to the origins of the masticatory muscles. Regions of the model under compressive stress correspond closely to the arrangement of bony material in a hominoid skull. If only the stress-bearing finite elements on each section are combined, and the stress-free parts neglected, the resulting three-dimensional shape is surprisingly similar to a hominoid skull. If bite forces are applied to parts of the tooth row only, the stress patterns are lower, asymmetrical and do not spread into all regions that are stress-bearing in simultaneous biting on all teeth. In model 2, the highest stresses occur at the tooth roots and along the forehead on top of the nasal roof. There are no marked stress concentrations on top of the orbits. The resulting shape resembles that of an orang-utan. In model 3, the highest stresses also occur at the tooth roots, but the circles of force mostly close below the brain case, so that the stress concentration in the forehead region remains much less marked. In this model, however, the stress concentrations are very similar to hollow brow ridges. The entire resulting shape resembles that of gorilla or chimpanzee skulls. A typical gracile australopithecine skull (STS-5) also shows clear similarities to the patterns of stress flow in our models

  5. Cave crawling in zebra Finch skulls

    DEFF Research Database (Denmark)

    Larsen, Ole Næsbye; Salomon, Rasmus; Jensen, Kenneth Kragh;

    2014-01-01

    The middle ears of birds are acoustically coupled through an air-filled interaural canal, often illustrated and modelled as a simple tube. It allows sound to propagate through the skull from one ear to the other and considerably enhance the cues for directional hearing by interaction with the...... by anatomical adaptations during evolution. A closer inspection of the zebra finch cranium using micro-CT scanning reveals that not only is IAC trabeculated and irregularly shaped but it also communicates with a set of highly complex, air-filled canals in the skull extending to the base of the beak...

  6. Superficial peroneal neurocutaneous flap based on an anterior tibial artery perforator for forefoot reconstruction.

    Science.gov (United States)

    Wang, Chun-Yang; Chai, Yi-Min; Wen, Gen; Han, Pei; Cheng, Liang

    2015-06-01

    The distally based superficial peroneal neurocutaneous (SPNC) island flap has been widely used for foot reconstruction. It is based on the descending branch of the peroneal artery perforator. However, damage to the perimalleolar vascularization or anatomic variations of the descending branch often causes flap necrosis. Because septocutaneous perforators from the anterior tibial artery participate in the vascular network of superficial peroneal nerve in the distal lower leg, a modified SPNC flap is designed based on the anterior tibial artery perforator. Seven patients with soft tissue defect over the forefoot were treated by this modified technique. Six patients had accompanied injuries at the lateral perimalleolar region, and 1 patient had an anatomic variation of the descending branch of the peroneal artery perforator. The size of defect ranged from 12 × 5 to 15 × 9 cm. All 7 flaps survived completely without complications. The size of the flaps ranged from 13 × 6 to 16 × 10 cm. No severe venous congestion occurred. The mean follow-up was 9.4 months (range, 6-14 months). All patients were satisfied with the texture and color of the flaps. Two patients complained about the thickness of the flaps, but did not want further operation. The donor sites healed uneventfully and no painful neuroma occurred. In conclusion, the modified SPNC flap based on an anterior tibial artery perforator is a feasible salvage procedure when the traditional design is unreliable. It can provide sufficient and superior coverage for large forefoot defect. PMID:25969973

  7. [Apical petrositis, osteomyelitis of the base of the skull bones and of the first cervical vertebra in a 5 year-old children following chicken pox].

    Science.gov (United States)

    Bogomil'sky, M R; Polunin, M M; Zelikovich, E I; Soldatsky, Yu L; Burova, O V

    2016-01-01

    This publication was designed to describe a rare case of development of apicalpetrositis in a child presenting with acute otitis mediafollowing chicken pox experienced in the preceding period. We carried out the study with the use of computed tomography (CT) that demonstrated destruction of the temporal bone, bones of the base of the skull and of the first cervical vertebra. The treatment strategy chosen for the management of this condition that included antibiotic therapy and expectant observation proved justified and can be recommended as an algorithm of choice taking into consideration the difficulty of surgical approach to the apex of the petrous pyramid. However, this approach is associated with the high risk of disability arising from the potential injury to the craniocerebral nerves. PMID:26977573

  8. Positron Emission Tomography/Computed Tomography Imaging of Residual Skull Base Chordoma Before Radiotherapy Using Fluoromisonidazole and Fluorodeoxyglucose: Potential Consequences for Dose Painting

    Energy Technology Data Exchange (ETDEWEB)

    Mammar, Hamid, E-mail: hamid.mammar@unice.fr [Radiation Oncology Department, Antoine Lacassagne Center, Nice (France); CNRS-UMR 6543, Institute of Developmental Biology and Cancer, University of Nice Sophia Antipolis, Nice (France); Kerrou, Khaldoun; Nataf, Valerie [Department of Nuclear Medicine and Radiopharmacy, Tenon Hospital, and University Pierre et Marie Curie, Paris (France); Pontvert, Dominique [Proton Therapy Center of Orsay, Curie Institute, Paris (France); Clemenceau, Stephane [Department of Neurosurgery, Pitie-Salpetriere Hospital, Paris (France); Lot, Guillaume [Department of Neurosurgery, Adolph De Rothschild Foundation, Paris (France); George, Bernard [Department of Neurosurgery, Lariboisiere Hospital, Paris (France); Polivka, Marc [Department of Pathology, Lariboisiere Hospital, Paris (France); Mokhtari, Karima [Department of Pathology, Pitie-Salpetriere Hospital, Paris (France); Ferrand, Regis; Feuvret, Loiec; Habrand, Jean-louis [Proton Therapy Center of Orsay, Curie Institute, Paris (France); Pouyssegur, Jacques; Mazure, Nathalie [CNRS-UMR 6543, Institute of Developmental Biology and Cancer, University of Nice Sophia Antipolis, Nice (France); Talbot, Jean-Noeel [Department of Nuclear Medicine and Radiopharmacy, Tenon Hospital, and University Pierre et Marie Curie, Paris (France)

    2012-11-01

    Purpose: To detect the presence of hypoxic tissue, which is known to increase the radioresistant phenotype, by its uptake of fluoromisonidazole (18F) (FMISO) using hybrid positron emission tomography/computed tomography (PET/CT) imaging, and to compare it with the glucose-avid tumor tissue imaged with fluorodeoxyglucose (18F) (FDG), in residual postsurgical skull base chordoma scheduled for radiotherapy. Patients and Methods: Seven patients with incompletely resected skull base chordomas were planned for high-dose radiotherapy (dose {>=}70 Gy). All 7 patients underwent FDG and FMISO PET/CT. Images were analyzed qualitatively by visual examination and semiquantitatively by computing the ratio of the maximal standardized uptake value (SUVmax) of the tumor and cerebellum (T/C R), with delineation of lesions on conventional imaging. Results: Of the eight lesion sites imaged with FDG PET/CT, only one was visible, whereas seven of nine lesions were visible on FMISO PET/CT. The median SUVmax in the tumor area was 2.8 g/mL (minimum 2.1; maximum 3.5) for FDG and 0.83 g/mL (minimum 0.3; maximum 1.2) for FMISO. The T/C R values ranged between 0.30 and 0.63 for FDG (median, 0.41) and between 0.75 and 2.20 for FMISO (median,1.59). FMISO T/C R >1 in six lesions suggested the presence of hypoxic tissue. There was no correlation between FMISO and FDG uptake in individual chordomas (r = 0.18, p = 0.7). Conclusion: FMISO PET/CT enables imaging of the hypoxic component in residual chordomas. In the future, it could help to better define boosted volumes for irradiation and to overcome the radioresistance of these lesions. No relationship was founded between hypoxia and glucose metabolism in these tumors after initial surgery.

  9. The skull in renal osteodystrophy

    International Nuclear Information System (INIS)

    Skull X-ray of 60 patients with chronic renal failure were examined. Alterations included diminished or increased bone density, radiolucent areas, pepper pot skull and the disappearance of vascular grooves and sutures. It is suggested that the radiological aspect of the skull is of very little diagnostic use in the assessment of uremic osteopathy since specific alterations are rare and tardive and show no correlation with clinical and laboratory findings. Skull X-ray can be usefull in assessing the effects of treatment (vitamin D derivaties, parathyroidectomy) and for the identification of focal lesions (brown tumors)

  10. The plastered skulls from the Pre-Pottery Neolithic B site of Yiftahel (Israel)--a computed tomography-based analysis.

    Science.gov (United States)

    Slon, Viviane; Sarig, Rachel; Hershkovitz, Israel; Khalaily, Hamoudi; Milevski, Ianir

    2014-01-01

    Three plastered skulls, dating to the Pre-Pottery Neolithic B, were found at the site of Yiftahel, in the Lower Galilee (Israel). The skulls underwent refitting and restoration processes, details of which are described herein. All three belong to adults, of which two appear to be males and one appears to be a female. Virtual cross-sections were studied and a density analysis of the plaster was performed using computed tomography scans. These were utilized to yield information regarding the modeling process. Similarities and differences between the Yiftahel and other plastered skulls from the Levant are examined. The possible role of skull plastering within a society undergoing a shift from a hunting-gathering way of life to a food producing strategy is discussed. PMID:24586625

  11. [The skull of Combe Capelle].

    Science.gov (United States)

    Hoffmann, Almut; Wegner, Dietrich

    2002-12-01

    Since the end of World War II two of the most important anthropological artefacts of the Museum für Vor- und Frühgeschichte in Berlin, the skulls and skeletons of Le Moustier and Combe Capelle, were believed to be missing or destroyed, respectively. The postcrania were severely damaged during a fire after the museum was bombed in February 1945, while the skulls were brought to the Soviet Union in 1945. In 1965, the skull of the Neanderthal man from Le Moustier and the chain of the grave of Combe Capelle were found amongst the art objects returned by the Soviet Union into the German Democratic Republic in 1958. However, the Combe Capelle skull was still missing. In the end of 2001 this skull could be found and identified in a store-house of the museum. Now, one the oldest known representatives of Homo sapiens sapiens is again available for scientific research and public exhibitions. PMID:12529957

  12. Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull

    International Nuclear Information System (INIS)

    Purpose: To determine the temporal lobe (TL) damage rate in 96 patients treated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull. Methods and Materials: The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as 'primary tumors' and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group no. 85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose-volume histograms were obtained for these patients. Results: Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from

  13. Fractionated stereotactic radiotherapy of benign skull-base tumors: a dosimetric comparison of volumetric modulated arc therapy with Rapidarc® versus non-coplanar dynamic arcs

    International Nuclear Information System (INIS)

    Benign tumors of the skull base are a challenge when delivering radiotherapy. An appropriate choice of radiation technique may significantly improve the patient’s outcomes. Our study aimed to compare the dosimetric results of fractionated stereotactic radiotherapy between non-coplanar dynamic arcs and coplanar volumetric modulated arctherapy (Rapidarc®). Thirteen patients treated with Novalis TX® were analysed: six vestibular schwannomas, four pituitary adenomas and three meningioma. Two treatment plans were created for each case: dynamic arcs (4–5 non coplanar arcs) and Rapidarc® (2 coplanar arcs). All tumors were >3 cm and accessible to both techniques. Patients had a stereotactic facemask (Brainlab) and were daily repositioned by Exactrac®. GTV and CTV were contoured according to tumor type. A 1-mm margin was added to the CTV to obtain PTV. Radiation doses were 52.2–54 Gy, using 1.8 Gy per fraction. Treatment time was faster with Rapidarc®. The mean PTV V95 % was 98.8 for Rapidarc® and 95.9 % for DA (p = 0.09). Homogeneity index was better with Rapidarc®: 0.06 vs. 0.09 (p = 0.01). Higher conformity index values were obtained with Rapidarc®: 75.2 vs. 67.9 % (p = 0.04). The volume of healthy brain that received a high dose (V90 %) was 0.7 % using Rapidarc® vs. 1.4 % with dynamic arcs (p = 0.05). Rapidarc® and dynamic arcs gave, respectively, a mean D40 % of 10.5 vs. 18.1 Gy (p = 0.005) for the hippocampus and a Dmean of 25.4 vs. 35.3 Gy (p = 0.008) for the ipsilateral cochlea. Low-dose delivery with Rapidarc® and dynamic arcs were, respectively, 184 vs. 166 cm3 for V20 Gy (p = 0.14) and 1265 vs. 1056 cm3 for V5 Gy (p = 0.67). Fractionated stereotactic radiotherapy using Rapidarc® for large benign tumors of the skull base provided target volume coverage that was at least equal to that of dynamics arcs, with better conformity and homogeneity and faster treatment time. Rapidarc® also offered better sparing of the ipsilateral cochlea and hippocampus

  14. Cervicoplastia anterior Anterior cervicoplasty

    Directory of Open Access Journals (Sweden)

    Lucas Gomes Patrocínio

    2004-10-01

    Full Text Available Muitos pacientes buscam correção estética da frouxidão da pele do pescoço, depósito de gordura na região submentoneana ou bandas de platisma. Em grande parte dos casos a ação medial, via cervicoplastia anterior é necessária. OBJETIVO: Demonstrar a casuística e avaliar os resultados e complicações com a técnica de cervicoplastia anterior no Serviço de Otorrinolaringologia da Universidade Federal de Uberlândia. FORMA DE ESTUDO: Relato de série. PACIENTES E MÉTODOS: Quarenta e dois pacientes, entre 39 e 65 anos de idade, sendo 40 (95,2% do sexo feminino e 2 (4,8% do masculino, foram submetidos a cervicoplastia anterior. Retrospectivamente foram avaliados resultados e complicações. RESULTADOS: Destes, 34 apresentaram resultados satisfatórios, 4 apresentaram déficit estético notado somente pelo cirurgião, 3 apresentaram déficit estético notado somente pelo paciente e 1 apresentou déficit estético necessitando cirurgia revisional. Ao estudo fotográfico, todos os pacientes apresentaram melhora do perfil cervical, redução das bandas de platisma e da frouxidão da pele, estabilização da musculatura cervical e acentuação do ângulo cervicomental, em graus variados. Houve complicação em 2 casos (discreto serohematoma e cicatriz um pouco alargada. CONCLUSÃO: A cervicoplastia, associada ou não à tração lateral pela ritidoplastia, é uma técnica que produz resultados satisfatórios na grande maioria dos casos.Many patients look for aesthetic correction of the laxity of neck skin, submandibular fat deposit or platisma bands. In a large part of the cases, medial action, through anterior cervicoplasty is necessary. AIM: To demonstrate the casuistic and to evaluate the results and complications with anterior cervicoplasty technique in the Otorhinolaryngology Service of the Federal University of Uberlândia. STUDY DESIGN: Serie report. PATIENTS AND METHODS: Forty-two patients, between 39 and 65 years of age, being 40 (95

  15. Predicting and Preventing Skull Overheating in Non Invasive Brain HIFU Treatment Protocols

    International Nuclear Information System (INIS)

    Ultrasound brain therapy is currently limited by the strong phase and amplitude aberrations induced by the heterogeneities of the skull. However the development of aberration correction techniques has made it possible to correct the beam distortion induced by the skull and to produce a sharp focus in the brain. Moreover, using the density of the skull bone that can be obtained with high-resolution CT scans, the corrections needed to produce this sharp focus can be calculated using ultrasound propagation models. We propose here a model for computing the temperature elevation in the skull during High Intensity Focused Ultrasound (HIFU) transcranial therapy. Based on CT scans, the wave propagation through the skull is computed with 3D finite differences wave propagation software. The acoustic simulation is combined with a 3D thermal diffusion code and the temperature elevation inside the skull is computed. Finally, the simulation is validated experimentally by measuring the temperature elevation in several locations of the skull

  16. Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

    Directory of Open Access Journals (Sweden)

    Yasunori Fujimoto

    2015-07-01

    Full Text Available Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40% and 4 (4.4% patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%.Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.

  17. Development of induction skull melting technology

    International Nuclear Information System (INIS)

    BARC had developed and indigenized cold crucible induction melter technology for high temperature glass melting applications. In order to extend this technology for metal melting applications, development of Induction Skull Melting was undertaken. As a part of the indigenous development of the ISM technology, a systematic numerical simulation was carried out initially to arrive at the design parameters of the segmented crucible. Based on the model-based design, an induction skull melting facility comprising of a water-cooled segmented copper crucible with in-situ casting module, induction heating power supply system, cooling water recirculation systems, vacuum chamber with vacuum delivery system and associated instrumentation and control units was built. The ISM facility was successfully tested for melting and homogenizing different metals and alloys. The ISM technology is the most preferred technology when highly refractory and extremely reactive metals and their alloys are to be processed with ultra high purity. (author)

  18. The diagnostic value of high resolution spiral CT in fracture of the skull base%高分辨率螺旋 CT 对颅底骨折的诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐柱荣

    2014-01-01

    目的:探讨高分辨率螺旋CT扫描对颅底骨折的诊断价值。方法对57例临床疑有颅底骨折的患者先行常规CT扫描,然后行高分辨率螺旋CT扫描,并对结果进行对比分析。结果57例患者中高分辨率螺旋CT扫描检出颅底骨折45例,常规CT扫描检出10例,两者比较差异具有统计学意义( P<0.01)。结论螺旋CT高分辨率检查技术显著提高颅底骨折的检出率,对临床治疗有重要的指导意义,应作为常规检查方法。%Objective To explore the diagnosis value of high resolution spiral CT scan in fracture of the skull base .Methods Fifty-seven patients with clinically suspected skull base fracture received conventional CT scan -ning first, then received high resolution spiral CT scanning , and the result analysis were compared .Results In 57 patients, 45 cases of fracture of the skull base were detected by high resolution spiral CT scan , 10 cases were detec-ted by conventional CT scanning , showing significant difference between two methods ( P<0.01 ) .Conclusion Spi-ral CT high-resolution technique significantly increase the detection rate of the fracture of the skull base , and has im-portant guiding significance to the clinical treatment , should be used as a routine examination method .

  19. Association of Anterior and Lateral Extraprostatic Extensions with Base-Positive Resection Margins in Prostate Cancer

    Science.gov (United States)

    Abalajon, Mark Joseph; Jang, Won Sik; Kwon, Jong Kyou; Yoon, Cheol Yong; Lee, Joo Yong; Cho, Kang Su; Ham, Won Sik

    2016-01-01

    Introduction Positive surgical margins (PSM) detected in the radical prostatectomy specimen increase the risk of biochemical recurrence (BCR). Still, with formidable number of patients never experiencing BCR in their life, the reason for this inconsistency has been attributed to the artifacts and to the spontaneous regression of micrometastatic site. To investigate the origin of margin positive cancers, we have looked into the influence of extraprostatic extension location on the resection margin positive site and its implications on BCR risk. Materials & Methods The clinical information and follow-up data of 612 patients who had extraprostatic extension and positive surgical margin at the time of robot assisted radical prostatectomy (RARP) in the single center between 2005 and 2014 were modeled using Fine and Gray’s competing risk regression analysis for BCR. Extraprostatic extensions were divided into categories according to location as apex, base, anterior, posterior, lateral, and posterolateral. Extraprostatic extensions were defined as presence of tumor beyond the borders of the gland in the posterior and posterolateral regions. Tumor admixed with periprostatic fat was additionally considered as having extraprostatic extension if capsule was vague in the anterior, apex, and base regions. Positive surgical margins were defined as the presence of tumor cells at the inked margin on the inspection under microscopy. Association of these classifications with the site of PSM was evaluated by Cohen’s Kappa analysis for concordance and logistic regression for the odds of apical and base PSMs. Results Median follow-up duration was 36.5 months (interquartile range[IQR] 20.1–36.5). Apex involvement was found in 158 (25.8%) patients and base in 110 (18.0%) patients. PSMs generally were found to be associated with increased risk of BCR regardless of location, with BCR risk highest for base PSM (HR 1.94, 95% CI 1.40–2.68, p<0.001) after adjusting for age, initial

  20. On-Board Imaging Validation of Optically Guided Stereotactic Radiosurgery Positioning System for Conventionally Fractionated Radiotherapy for Paranasal Sinus and Skull Base Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Maxim, Peter G.; Loo, Billy W.; Murphy, James D.; Chu, Karen P.M.; Hsu, Annie [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Le, Quynh-Thu, E-mail: Qle@stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States)

    2011-11-15

    Purpose: To evaluate the positioning accuracy of an optical positioning system for stereotactic radiosurgery in a pilot experience of optically guided, conventionally fractionated, radiotherapy for paranasal sinus and skull base tumors. Methods and Materials: Before each daily radiotherapy session, the positioning of 28 patients was set up using an optical positioning system. After this initial setup, the patients underwent standard on-board imaging that included daily orthogonal kilovoltage images and weekly cone beam computed tomography scans. Daily translational shifts were made after comparing the on-board images with the treatment planning computed tomography scans. These daily translational shifts represented the daily positional error in the optical tracking system and were recorded during the treatment course. For 13 patients treated with smaller fields, a three-degree of freedom (3DOF) head positioner was used for more accurate setup. Results: The mean positional error for the optically guided system in patients with and without the 3DOF head positioner was 1.4 {+-} 1.1 mm and 3.9 {+-} 1.6 mm, respectively (p <.0001). The mean positional error drifted 0.11 mm/wk upward during the treatment course for patients using the 3DOF head positioner (p = .057). No positional drift was observed in the patients without the 3DOF head positioner. Conclusion: Our initial clinical experience with optically guided head-and-neck fractionated radiotherapy was promising and demonstrated clinical feasibility. The optically guided setup was especially useful when used in conjunction with the 3DOF head positioner and when it was recalibrated to the shifts using the weekly portal images.

  1. On-Board Imaging Validation of Optically Guided Stereotactic Radiosurgery Positioning System for Conventionally Fractionated Radiotherapy for Paranasal Sinus and Skull Base Cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate the positioning accuracy of an optical positioning system for stereotactic radiosurgery in a pilot experience of optically guided, conventionally fractionated, radiotherapy for paranasal sinus and skull base tumors. Methods and Materials: Before each daily radiotherapy session, the positioning of 28 patients was set up using an optical positioning system. After this initial setup, the patients underwent standard on-board imaging that included daily orthogonal kilovoltage images and weekly cone beam computed tomography scans. Daily translational shifts were made after comparing the on-board images with the treatment planning computed tomography scans. These daily translational shifts represented the daily positional error in the optical tracking system and were recorded during the treatment course. For 13 patients treated with smaller fields, a three-degree of freedom (3DOF) head positioner was used for more accurate setup. Results: The mean positional error for the optically guided system in patients with and without the 3DOF head positioner was 1.4 ± 1.1 mm and 3.9 ± 1.6 mm, respectively (p <.0001). The mean positional error drifted 0.11 mm/wk upward during the treatment course for patients using the 3DOF head positioner (p = .057). No positional drift was observed in the patients without the 3DOF head positioner. Conclusion: Our initial clinical experience with optically guided head-and-neck fractionated radiotherapy was promising and demonstrated clinical feasibility. The optically guided setup was especially useful when used in conjunction with the 3DOF head positioner and when it was recalibrated to the shifts using the weekly portal images.

  2. Mastoid emissary in Indian skulls.

    Science.gov (United States)

    Piasecki, K; Wysocki, J

    1998-01-01

    Two hundred and eleven Indian skulls originating from medieval times, South of Peru, were studied in respect to variability of the mastoid emissary. Occurrence and localisation of the external orifice of the mastoid emissary were studied in three distinct and well-separated populations, living in the three different places: Villa el Salvador, Tablada de Lurin and Paracas. Most of the skulls presented considerable degree of artificial deformation. External orifice of the mastoid emissary was multiple in most of the skulls, especially in Villa el Salvador and Paracas populations. Mastoid emissaries in Indian were situated generally higher than in European, especially regarding the Paracas population. Significant sex differences were present in this material, regarded as a whole (summarized results for the three populations), what is in agreement with previous observations on European skulls. It indicates that even in cases of relatively deep deformation, some characteristic features of sex dimorphism of the human skull are noticeable. Additionally, the three studied populations, which were well separated from each other and lived alone, differed significantly regarding localization of the mastoid emissaries. PMID:9857576

  3. The development of the skull of the Egyptian Cobra Naja h. haje (Squamata: Serpentes: Elapidae.

    Directory of Open Access Journals (Sweden)

    Eraqi R Khannoon

    Full Text Available The study of craniofacial development is important in understanding the ontogenetic processes behind morphological diversity. A complete morphological description of the embryonic skull development of the Egyptian cobra, Naja h. haje, is lacking and there has been little comparative discussion of skull development either among elapid snakes or between them and other snakes.We present a description of skull development through a full sequence of developmental stages of the Egyptian cobra, and compare it to other snakes. Associated soft tissues of the head are noted where relevant. The first visible ossification centres are in the supratemporal, prearticular and surangular, with slight ossification visible in parts of the maxilla, prefrontal, and dentary. Epiotic centres of ossification are present in the supraoccipital, and the body of the supraoccipital forms from the tectum posterior not the tectum synoticum. The venom glands are visible as distinct bodies as early at stage 5 and enlarge later to extend from the otic capsule to the maxilla level with the anterior margin of the eye. The gland becomes more prominent shortly before hatching, concomitant with the development of the fangs. The tongue shows incipient forking at stage 5, and becomes fully bifid at stage 6.We present the first detailed staging series of cranial development for the Egyptian cobra, Naja h. haje. This is one of the first studies since the classical works of G. de Beer and W. Parker that provides a detailed description of cranial development in an advanced snake species. It allows us to correct errors and misinterpretations in previous accounts which were based on a small sample of specimens of uncertain age. Our results highlight potentially significant variation in supraoccipital formation among squamates and the need for further research in this area.

  4. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  5. Virtual Human Skull Model: A Three Dimensional Reconstruction Method Based on CT Serial Images%基于CT断层影像的颅骨解剖结构三维重建

    Institute of Scientific and Technical Information of China (English)

    吴辉群; 吴兴; 严培培; 耿兴云; 张远鹏; 蒋葵; 韩笑; 吕广明; 董建成

    2011-01-01

    Objective : To make three dimensional reconstruction of skull with Mimics8. 01 based on CT cranial serial images to provide models for anatomical study and research. Methods : Mimics software was used to make automated threshold segmentation of hone tissue in CT cranial images. After skull reconstruction, the hyoid bone was split automatically. While to other skull bones, in three different panels of CT images under Mimics, locating line comhined with anatomical knowledge of skull bone relations were used to detect the locating point between two neighboring bones. Then, the separate region of bones was manually marked in different colors designed before. The main neurocranium and facial cranium structures were reconstructed and observed in computer. Results:The skull composed bones such as frontal, temporal, occipital, parietal, sphenoid, ethmoid, nasal, lacrimal, maxilla, mandible, jaw, hyoid bones were successfully segmented with different colors and constructed, which could be observed arbitrarily in computer in single or combination form. Conclusions :Virtual skull model can be reconstructed based on CT cranial serial images, which provides basis for digital skull anatomy teaching and cranial surgical navigation.%目的:基于CT颅脑断面连续影像,利用Mimics 8.01软件对颅骨进行三维重建,为解剖学教学和研究提供模型.方法:利用Mimics软件对CT颅脑影像中的骨组织进行自动阈值分割后,对重建出的颅骨进行自动分割,分割出舌骨结构.对于其他颅骨结构,在Mimics软件中的三个方位CT图像中,利用定位线结合解剖学中的颅骨毗邻关系,找出区分毗邻颅骨之间的定位点.然后,根据事先规划的不同结构的分割颜色,人工描出相应的颅骨所在区域.随后,对分割出的各个颜色区域进行三维重建,重建出主要的脑颅骨和面颅骨结构,并分别在计算机上对上述结构进行观察.结果:成功对颅骨的结构分别以不同颜色进行分

  6. CT of the skull base

    International Nuclear Information System (INIS)

    For the middle ear only the crus longus incudis and the stapedius still requires conventional tomography. This substitution of CT for classical tomography, welcome in itself is limited by financial considerations. However, when CT is necessary it should be done before tomography thus possibly limiting both expense and radiation dose. (orig./AJ)

  7. Skull development in the muscular dystrophic mouse

    DEFF Research Database (Denmark)

    Vilmann, H; Kirkeby, S; Moss, M L

    1989-01-01

    Roentgencephalometric tracings of skulls of 7-week-old normal and muscular dystrophic mice were compared. A marked size reduction of the dystrophic skulls relative to the normal ones was observed. However, the visceral parts of the dystrophic skull were more reduced in size than the neural parts....

  8. Cloverleaf skull with generalised bone dysplasia

    International Nuclear Information System (INIS)

    A case of cloverleaf skull with generalised bone dysplasia is reported. The authors believe that bone dysplasia associated with cloverleaf is neither identical with thanatophoric dysplasia nor achondroplasia. Until identity of thanatophoric dysplasia and cloverleaf skull with generalised bone dysplasia is proved the diseases should be looked upon as separate entities and the wording ''thanatophoric dysplasia with cloverleaf skull'' should be abolished. (orig.)

  9. Pitfalls of voxel-based amyloid PET analyses for diagnosis of Alzheimer's disease. Artifacts due to non-specific uptake in the white matter and the skull

    International Nuclear Information System (INIS)

    Two methods are commonly used in brain image voxel-based analyses widely used for dementia work-ups: 3-dimensional stereotactic surface projections (3D-SSP) and statistical parametric mapping (SPM). The methods calculate the Z-scores of the cortical voxels that represent the significance of differences compared to a database of brain images with normal findings, and visualize them as surface brain maps. The methods are considered useful in amyloid positron emission tomography (PET) analyses to detect small amounts of amyloid-β deposits in early-stage Alzheimer's disease (AD), but are not fully validated. We analyzed the 11C-labeled 2-(2-[2-dimethylaminothiazol-5-yl]ethenyl)-6-(2-[fluoro]ethoxy)benzoxazole (BF-227) amyloid PET imaging of 56 subjects (20 individuals with mild cognitive impairment [MCl], 19 AD patients, and 17 non-demented [ND] volunteers) with 3D-SSP and the easy Z-score imaging system (eZIS) that is an SPM-based method. To clarify these methods' limitations, we visually compared Z-score maps output from the two methods and investigated the causes of discrepancies between them. Discrepancies were found in 27 subjects (9 MCl, 13 AD, and 5 ND). Relatively high white matter uptake was considered to cause higher Z-scores on 3D-SSP in 4 subjects (1 MCl and 3 ND). Meanwhile, in 17 subjects (6 MCl, 9 AD, and 2 ND), Z-score overestimation on eZIS corresponded with high skull uptake and disappeared after removing the skull uptake ('scalping'). Our results suggest that non-specific uptakes in the white matter and skull account for errors in voxel-based amyloid PET analyses. Thus, diagnoses based on 3D-SSP data require checking white matter uptake, and 'scalping' is recommended before eZIS analysis. (author)

  10. Infantile myofibromatosis of the skull

    International Nuclear Information System (INIS)

    Infantile myofibromatosis is a rare benign tumor of childhood characterized by a myofibroblastic tumor in the skin, subcutaneous tissues, bones, and, occasionally, the viscera. The tumor may be solitary or multicentric. A solitary skeletal lesion most commonly occurs in the craniofacial region. We report a case of solitary infantile myofibromatosis of the skull, confirmed by excisional biopsy. (author)

  11. Benchmarking of a treatment planning system for spot scanning proton therapy: Comparison and analysis of robustness to setup errors of photon IMRT and proton SFUD treatment plans of base of skull meningioma

    Energy Technology Data Exchange (ETDEWEB)

    Harding, R., E-mail: ruth.harding2@wales.nhs.uk [St James’s Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Abertawe Bro Morgannwg University Health Board, Medical Physics and Clinical Engineering, Swansea SA2 8QA (United Kingdom); Trnková, P.; Lomax, A. J. [Paul Scherrer Institute, Centre for Proton Therapy, Villigen 5232 (Switzerland); Weston, S. J.; Lilley, J.; Thompson, C. M.; Cosgrove, V. P. [St James’s Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF (United Kingdom); Short, S. C. [Leeds Institute of Molecular Medicine, Oncology and Clinical Research, Leeds LS9 7TF, United Kingdomand St James’s Institute of Oncology, Oncology, Leeds LS9 7TF (United Kingdom); Loughrey, C. [St James’s Institute of Oncology, Oncology, Leeds LS9 7TF (United Kingdom); Thwaites, D. I. [St James’s Institute of Oncology, Medical Physics and Engineering, Leeds LS9 7TF, United Kingdomand Institute of Medical Physics, School of Physics, University of Sydney, Sydney NSW 2006 (Australia)

    2014-11-01

    Purpose: Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was to benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. Methods: Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. Results: It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. Conclusions: Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.

  12. The hot skull: Malignant or feminine

    International Nuclear Information System (INIS)

    Diffusely increased uptake in the calvarium on bone scintigraphy (a hot skull) is often present in patients with bone metastases and metabolic diseases. Excluding these known facts the prevalence of the hot skull and its relation with malignancy and, more specifically, with breast carcinoma have been studied in 673 patients. In women, the hot skull is clearly related to malignancy and to a lesser extent to breast carcinoma. However, another remarkable feature of the hot skull is its predominance in women in general (compared to men) and, therefore, the data suggest that the hot skull can also represent a normal variant of the female skull. We conclude that the hot skull has no clinical value in screening protocols. (orig.)

  13. Analysis on the diagnosis and treatment of the fractures of the anterior cranial fossa in the 26 cases

    International Nuclear Information System (INIS)

    Objective: To study the diagnosis and treatment of anterior cranial fossa fracture. Methods: The medical records of 26 patients treated were reviewed retrospectively. All cases were examined by CT imaging scans preoperatively. The total cases were divided into three types. The types of operation such as acute decompress, skull base reconstruction, dural repairement, optical canaldompress were performed. Results: Only one case developed postoperative cerebrospinal fluid leakage in the chronic period. After using repair operation, the patient recovered. Three cases visual impairement did not recover postoperativaly. Two patients died. Conclusion: Verification of the fracture types and initial necerological systemic impairments by means of CT scanning is important preoperatively. It is very effective to prevent cerebrospinal fluid leakage if the dura is repaired and the skull base recons-tructed in primury operation

  14. Early surgery of ruptured anterior circulation aneurysm based on multislice helical computerised tomography angiography.

    Science.gov (United States)

    Hui, Ma; Dong, Wang Xiao; Ciceri, E; Marras, C; Tao, Sun; Chun, Xia He; Zheng, Li Zong; Fang, Li Guo

    2007-12-01

    The purpose of this study is to evaluate the utility of three-dimensional computed tomographic angiography (3D-CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid haemorrhage (SAH) from anterior circulation aneurysms, and to correlate the results with digital subtraction angiography (DSA) and intraoperative findings. From May 2005 to May 2007 a total of 38 consecutive patients admitted for SAH, suspicious for ruptured anterior circulation cerebral aneurysm, underwent 3D-CTA. Inclusion criteria were a SAH confirmed by a non-contrast head computed tomographic scan or by lumbar puncture. Exclusion criteria were: previous DSA, severe contrast medium allergy and severe renal failure. All patients underwent early surgical clipping of the aneurysm. The mean time between SAH onset and surgery was 43.6 h (range, 14-74 h). The 3D-CTA was performed in all cases; and in 13 out of 38 patients (34%) represented the only preoperative exam. In all patients that underwent surgery with the sole 3D-CTA, the images collected allowed a good visualisation of the morphology of aneurysms and of the anatomical relationship with the vascular structures. 3D-CTA allows accurate diagnosis with an excellent visualisation of ruptured aneurysms of the anterior circulation. Our results suggest that, in selected cases, ruptured anterior circulation aneurysms could be successfully treated on the basis of 3D-CTA alone. PMID:18175079

  15. Hallazgos en el macizo facial y la base del cráneo de pacientes pediátricos con histiocitosis de células de Langerhans Craniofacial and skull base findings in Langerhans cell histiocytosis in pediatric patients

    Directory of Open Access Journals (Sweden)

    Daniel Forlino

    2013-03-01

    Full Text Available La histiocitosis de células de Langerhans (HCL es una entidad poco frecuente, con una incidencia anual de 2,6 a 5,4 por millón de niños en la población general. Tiene manifestaciones óseas (lesiones osteolíticas solitarias o múltiples en huesos planos, largos e irregulares o multisistémicas. Se describen los hallazgos imagenológicos de una serie retrospectiva de 17 pacientes pediátricos, de 1 a 12 años de edad, con histiocitosis de células de Langerhans en el macizo facial y la base del cráneo. Las manifestaciones incluyeron lesiones osteolíticas y masa de partes blandas, que ocupaban las cavidades adyacentes, como la órbita, los senos paranasales, la caja timpánica y la mastoides. En el maxilar inferior puede provocar reabsorción del reborde alveolar con apariencia de dientes flotantes. La complejidad anatómica del área de estudio requiere su valoración mediante tomografía computada (TC y resonancia magnética (RM con contraste. La histiocitosis de células de Langerhans debe considerarse dentro de los diagnósticos diferenciales de las lesiones del macizo facial y la base del cráneo, especialmente en pacientes pediátricos.Langerhans cell histiocytosis (CLH is an uncommon entity, of unknown etiology, with an incidence of 2.6 at 5.4 per 1,000,000 children/year in the general population. It may have bone manifestations (solitary or multiple osteolytic lesions in flat, long and irregular bones or multiorgan manifestations. We report the radiological findings in retrospective series of 17 pediatric patients aged 1 to 12 years old, with CLH in craniofacial and skull base. Radiological findings included osteolytic and soft tissue lesions occupying the orbit, sinuses, tympanic cavity and mastoid. In the mandible, reabsorption of the alveolar ridge with the appearance of floating teeth was observed. The anatomical complexity of the area studied required evaluation by CT and MRI with contrast. LCH disease should be considered in

  16. Ulnar nerve stability-based surgery for cubital tunnel syndrome via a small incision: a comparison with classic anterior nerve transposition

    OpenAIRE

    Kang, Ho-Jung; Koh, Il-Hyun; Chun, Yong-Min; Oh, Won-Taek; Chung, Kwang-Ho; Choi, Yun-Rak

    2015-01-01

    Objective The purpose of this study was to compare the clinical outcomes of ulnar nerve stability-based surgery via a small incision with those of classic anterior transposition of the ulnar nerve for cubital tunnel syndrome. Methods From March 2008 to December 2013, 107 patients with cubital tunnel syndrome underwent simple decompression or anterior transposition via a small incision, according to an ulnar nerve stability-based decision based on an assessment of intraoperative ulnar nerve st...

  17. Comparative histology of some craniofacial sutures and skull-base synchondroses in non-avian dinosaurs and their extant phylogenetic bracket.

    Science.gov (United States)

    Bailleul, Alida M; Horner, John R

    2016-08-01

    Sutures and synchondroses, the fibrous and cartilaginous articulations found in the skulls of vertebrates, have been studied for many biological applications at the morphological scale. However, little is known about these articulations at the microscopic scale in non-mammalian vertebrates, including extant archosaurs (birds and crocodilians). The major goals of this paper were to: (i) document the microstructure of some sutures and synchondroses through ontogeny in archosaurs; (ii) compare these microstructures with previously published sutural histology (i.e. that of mammals); and (iii) document how these articulations with different morphological degrees of closure (open or obliterated) appear histologically. This was performed with histological analyses of skulls of emus, American alligators, a fossil crocodilian and ornithischian dinosaurs (hadrosaurids, pachycephalosaurids and ceratopsids). Emus and mammals possess a sutural periosteum until sutural fusion, but it disappears rapidly during ontogeny in American alligators. This study identified seven types of sutural mineralized tissues in extant and extinct archosaurs and grouped them into four categories: periosteal tissues; acellular tissues; fibrous tissues; and intratendinous tissues. Due to the presence of a periosteum in their sutures, emus and mammals possess periosteal tissues at their sutural borders. The mineralized sutural tissues of crocodilians and ornithischian dinosaurs are more variable and can also develop via a form of necrosis for acellular tissues and metaplasia for fibrous and intratendinous tissues. It was hypothesized that non-avian dinosaurs, like the American alligator, lacked a sutural periosteum and that their primary mode of ossification involved the direct mineralization of craniofacial sutures (instead of intramembranous ossification found in mammals and birds). However, we keep in mind that a bird-like sutural microstructure might have arisen within non-avian saurichians. While

  18. Cloverleaf skull with generalised bone dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, K.; Warren, P.S.; Fisher, C.C.

    1985-09-01

    A case of cloverleaf skull with generalised bone dysplasia is reported. The authors believe that bone dysplasia associated with cloverleaf is neither identical with thanatophoric dysplasia nor achondroplasia. Until identity of thanatophoric dysplasia and cloverleaf skull with generalised bone dysplasia is proved the diseases should be looked upon as separate entities and the wording ''thanatophoric dysplasia with cloverleaf skull'' should be abolished.

  19. Aspergillus Osteomyelitis of the Skull.

    Science.gov (United States)

    Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark

    2016-07-01

    Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines. PMID:27391523

  20. Skull melting of synthetic minerals

    Energy Technology Data Exchange (ETDEWEB)

    Scott, S.D.; Hull, D.E.; Herrick, C.C.

    1977-12-01

    Direct high-frequency induction melting of dielectric materials in a water-cooled cage has been developed in the LASL synthetic minerals program. Molten material is contained in a skull, i.e., sintered shell, of its own composition so the traditional problems associated with refractory melt contamination are essentially eliminated. Preliminary analyses of power input, cage design, and coil geometry are discussed. Initial experimental results on the preparation of polycrystalline ingots, single crystals, and glasses are presented along with possible applications of this technique.

  1. Anterior tarsaltunnelsyndrom

    DEFF Research Database (Denmark)

    Miliam, Palle B; Basse, Peter N

    2009-01-01

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum of the ankle. It may be rare because it is underrecognized clinically.We present a case regarding a 29-year-old man, drummer, who for one and a half year experienced clinical...

  2. Applied anatomy of repairing skull base defect by temporal fascia (muscles) flaps%颞筋膜(肌)瓣转位重建颅底的应用解剖及修复组织缺损的作用

    Institute of Scientific and Technical Information of China (English)

    闫长祥; 于春江; 王忠诚; 刘海; 张忠

    2004-01-01

    AIM: To illustrate anatomical property, blood supply and nerve distribution of temporal fascia(muscles) flaps and explore their effects in repairing tissue defect, so as to provide an anatomical basis for skull base rebuilding.METHODS: Totally 20 wet skull samples from 10 patients were fixed with latex mixed of red and blue dyestuff into veins and arteries. After making frontal-temporal-crest incision, anatomy of each layer was photographed and measured.RESULTS: The layers from the surface to the deep were skin, hypodermic tissue, superficial temporal fascia(STF), deep temporal fascia(DTF), temporal muscle(TM) and periosteum. STF, DTF and TM had their own blood supplies.CONCLUSION: Different types of temporal fascia flaps, temporal muscle flaps and temporal fascia muscle flaps can be made for skull base rebuilding and tissue defect repair according to blood supplies.%目的:分析说明颞筋膜(肌)瓣的解剖位置、血供及神经分布,探讨其在修复组织缺损中的作用,并为进行颅底重建提供解剖学依据.方法:应用10例(20侧)成人头部湿标本,动、静脉系统分别灌注混有红、蓝色染料的乳胶;额颞顶联合切口,逐层解剖、拍照、测量.结果:该区层次由浅入深为:皮肤、皮下组织、颞浅筋膜、颞深筋膜、颞肌和骨膜.颞浅筋膜、颞深筋膜和颞肌均有各自的血液供应.结论:根据其血供可制成不同类型的颞筋膜瓣、颞肌瓣、颞筋膜肌瓣进行颅底重建及组织缺损的修复.

  3. Estimation of the skull insertion loss using an optoacoustic point source

    Science.gov (United States)

    Estrada, Héctor; Rebling, Johannes; Turner, Jake; Kneipp, Moritz; Shoham, Shy; Razansky, Daniel

    2016-03-01

    The acoustically-mismatched skull bone poses significant challenges for the application of ultrasonic and optical techniques in neuroimaging, still typically requiring invasive approaches using craniotomy or skull thinning. Optoacoustic imaging partially circumvents the acoustic distortions due to the skull because the induced wave is transmitted only once as opposed to the round trip in pulse-echo ultrasonography. To this end, the mouse brain has been successfully imaged transcranially by optoacoustic scanning microscopy. Yet, the skull may adversely affect the lateral and axial resolution of transcranial brain images. In order to accurately characterize the complex behavior of the optoacoustic signal as it traverses through the skull, one needs to consider the ultrawideband nature of the optoacoustic signals. Here the insertion loss of murine skull has been measured by means of a hybrid optoacoustic-ultrasound scanning microscope having a spherically focused PVDF transducer and pulsed laser excitation at 532 nm of a 20 μm diameter absorbing microsphere acting as an optoacoustic point source. Accurate modeling of the acoustic transmission through the skull is further performed using a Fourier-domain expansion of a solid-plate model, based on the simultaneously acquired pulse-echo ultrasound image providing precise information about the skull's position and its orientation relative to the optoacoustic source. Good qualitative agreement has been found between the a solid-plate model and experimental measurements. The presented strategy might pave the way for modeling skull effects and deriving efficient correction schemes to account for acoustic distortions introduced by an adult murine skull, thus improving the spatial resolution, effective penetration depth and overall image quality of transcranial optoacoustic brain microscopy.

  4. Breaking symmetry: the marine environment, prey size, and the evolution of asymmetry in cetacean skulls.

    Science.gov (United States)

    MacLeod, C D; Reidenberg, J S; Weller, M; Santos, M B; Herman, J; Goold, J; Pierce, G J

    2007-06-01

    Skulls of odontocetes (toothed whales, including dolphins and porpoises) are typified by directional asymmetry, particularly in elements associated with the airway. Generally, it is assumed this asymmetry is related to biosonar production. However, skull asymmetry may actually be a by-product of selection pressure for an asymmetrically positioned larynx. The odontocete larynx traverses the pharynx and is held permanently in place by a ring of muscle. This allows prey swallowing while remaining underwater without risking water entering the lungs and causing injury or death. However, protrusion of the larynx through the pharynx causes a restriction around which prey must pass to reach the stomach. The larynx and associated hyoid apparatus has, therefore, been shifted to the left to provide a larger right piriform sinus (lateral pharyngeal food channel) for swallowing larger prey items. This asymmetry is reflected in the skull, particularly the dorsal openings of the nares. It is hypothesized that there is a relationship between prey size and skull asymmetry. This relationship was examined in 13 species of odontocete cetaceans from the northeast Atlantic, including four narrow-gaped genera (Mesoplodon, Ziphius, Hyperoodon, and Kogia) and eight wide-gaped genera (Phocoena, Delphinus, Stenella, Lagenorhynchus, Tursiops, Grampus, Globicephala, and Orcinus). Skulls were examined from 183 specimens to assess asymmetry of the anterior choanae. Stomach contents were examined from 294 specimens to assess prey size. Results show there is a significant positive relationship between maximum relative prey size consumed and average asymmetry relative to skull size in odontocete species (wide-gape species: R2 = 0.642, P = 0.006; narrow-gape species: R2 = 0.909, P = 0.031). This finding provides support for the hypothesis that the directional asymmetry found in odontocete skulls is related to an aquatic adaptation enabling swallowing large, whole prey while maintaining respiratory

  5. Skull thickness in patients with clefts

    DEFF Research Database (Denmark)

    Arntsen, T; Kjaer, I; Sonnesen, L;

    2010-01-01

    The purpose was to analyze skull thickness in incomplete cleft lip (CL), cleft palate (CP), and combined cleft lip and palate (UCLP).......The purpose was to analyze skull thickness in incomplete cleft lip (CL), cleft palate (CP), and combined cleft lip and palate (UCLP)....

  6. The evolutionary significance of the Wajak skulls

    NARCIS (Netherlands)

    Storm, P.

    1995-01-01

    Ever since their description by Dubois (1920, 1922) the Wajak skulls Java) have played an important role in the discussions on the evolution of modern humans in Australasia. Because of the robust morphology of the skull, Wajak Man was seen as a link between Pleistocene hominids from Java (Solo) and

  7. Ontogenetic study of the skull in modern humans and the common chimpanzees: neotenic hypothesis reconsidered with a tridimensional Procrustes analysis.

    Science.gov (United States)

    Penin, Xavier; Berge, Christine; Baylac, Michel

    2002-05-01

    primarily the function of encephalization, but less so other parts of the skull. Our results, based on the discriminant function, reveal that additional structural traits (corresponding to the nonallometric part of the shape which is specific to humans) are rather situated in the other part of the skull. They mainly concern the equilibrium of the head related to bipedalism, and the respiratory and masticatory functions. Thus, the reduced prognathism, the flexed cranial base (forward position of the foramen magnum which is brought closer to the palate), the reduced anterior portion of the face, the reduced glabella, and the prominent nose mainly correspond to functional innovations which have nothing to do with a neotenic process in human evolution. The statistical analysis used here gives us the possibility to point out that some traits, which have been classically described as paedomorphic because they superficially resemble juvenile traits, are in reality independent of growth. PMID:11953945

  8. 鼻咽癌颅底侵犯冠状位CT扫描应用价值分析%Analysis on value of CT coronal scan in diagnosis of invasion of skull base in nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    骆忠华

    2012-01-01

    OBJECTIVE To discuss the clinical value of CT coronal scan in diagnosis of invasion of skull base in nasopharyn-geal carcinoma (NPC). METHODS 233 patients with NPC were given CT coronal and axial scan, then compared the results of the two positions. RESULTS In the 233 cases of NPC, CT coronal scan showed bone invasion in 4 cases in 16 cases that had not been recognized by axial scan. By CT coronal scan, the invasion of skull base was confirmed in 4 and excluded in 6 of 10 cases in which the invasion was uncertain by axial scan. Wider and deeper invasions were recognized in 23 cases (12.3%) by coronal scan, though obvious invasion had been diagnosed after axial scan. Accordant invasion was displayed in 35 cases (18.8%) by CT coronal and axial scan. By CT coronal scan, the invasion of skull base was in 21 patients witch had not been showed destruction of bone. And there was destruction of bone in 21 cases by axial scan, only 12 cases could be recognized in coronal scan, and with different locations. CONCLUSION CT scan is valuable for invasion of skull base in NPC, combining CT axial with coronal scan can improve diagnostic accuracy.%目的 探讨冠状位CT扫描在鼻咽癌颅底侵犯诊断中的应用价值.方法 对233例鼻咽癌患者进行轴位及冠状位CT扫描,比较两种体位对鼻咽癌颅底侵犯的检出情况.结果 轴位扫描所见肿瘤侵袭、转移灶中173例经冠状位扫描证实;轴位扫描无骨质侵袭及转移者16例中,经冠状位扫描见4例骨质破坏;轴位扫描所见10例难以确定是否骨质破坏者,经冠状位扫描证实4例骨质破坏,6例正常;另外,冠状位扫描显示了21例轴位扫描未发现的骨质破坏;同时有21例患者轴位扫描可见骨质破坏,但冠状位仅显示12例,且位置不同.结论 CT扫描在鼻咽癌颅底侵犯影像诊断中具有重要意义,但单纯轴位扫描具有一定局限性,联合应用轴位与冠状位的扫描,可提高诊断准确率.

  9. The conductivity of neonatal piglet skulls

    International Nuclear Information System (INIS)

    We report the first measured values of conductivities for neonatal mammalian skull samples. We measured the average radial (normal to the skull surface) conductivity of fresh neonatal piglet skull samples at 1 kHz and found it to be around 30 mS m−1 at ambient room temperatures of about 23 °C. Measurements were made on samples of either frontal or parietal cranial bone, using a saline-filled cell technique. The conductivity value we observed was approximately twice the values reported for adult skulls (Oostendorp et al 2000 IEEE Trans. Biomed. Eng. 47 1487–92) using a similar technique, but at a frequency of around 5 Hz. Further, we found that the conductivity of skull fragments increased linearly with thickness. We found evidence that this was related to differences in composition between the frontal and parietal bone samples tested, which we believe is because frontal bones contained a larger fraction of higher conductivity cancellous bone material

  10. An accessory skull suture mimicking a skull fracture.

    Science.gov (United States)

    Wiedijk, J E F; Soerdjbalie-Maikoe, V; Maat, G J R; Maes, A; van Rijn, R R; de Boer, H H

    2016-03-01

    This paper describes an investigation of the sudden and unexpected death of a five-and-a-half-month-old boy. As in every Dutch case of sudden unexpected death in infancy (SUDI), a multidisciplinary diagnostic approach was used. This included post-mortem radiography, showing a linear discontinuity of the parietal bone. Originally this was interpreted as a skull fracture, but autopsy indicated no signs of mechanical trauma. Instead the defect was defined as a unilateral accessory suture of the parietal bone. The initial erroneous diagnosis had severe adverse consequences and thus every health care professional or forensic specialist dealing with paediatric mechanical traumas should be cautious of this rare anomaly. PMID:26860068

  11. Dynamic photophysical processes in laser irradiated human cortical skull bone

    Science.gov (United States)

    Mandelis, Andreas; Kwan, Chi-Hang; Matvienko, Anna

    2009-02-01

    Modulated luminescence (LUM) technique was applied to analyze photophysical processes in the cortical layer of human skull bones. The theoretical interpretation of the results was based on the optical excitation and decay rate equations of the fluorophore and on the molecular interaction parameter with the photon field density in the matrix of the bone. Using comparisons of the theory with the frequency response of dental LUM it was concluded that the optically active molecular species (fluorophore) in the bones is hydroxyapatite. An effective relaxation lifetime of skull cortical bone was derived theoretically and was found to depend on the intrinsic fluorophore decay lifetime, on the photon field density, and on the thickness of the bone. The experimentally measured dependencies were in excellent agreement with the theoretical model. The theory was able to yield measurements of the optical scattering coefficient, optical absorption coefficient, and mean coupling coefficient. These results show that the quantitative LUM can be used as a sensitive method to measure optical properties of the active fluorophore in cortical skull bones and the optical-field-induced molecular interaction parameter. When calibrated vs. laser intensity, the modulated luminescence can also be used to measure human skull thickness. These traits can be applied to monitor the bone mineral density (BMD) and, ultimately can be used as potential markers of bone health or disease, such as osteoporosis or bone cancer.

  12. Statistical skull models from 3D X-ray images

    CERN Document Server

    Berar, M; Bailly, G; Payan, Y; Berar, Maxime; Desvignes, Michel; Payan, Yohan

    2006-01-01

    We present 2 statistical models of the skull and mandible built upon an elastic registration method of 3D meshes. The aim of this work is to relate degrees of freedom of skull anatomy, as static relations are of main interest for anthropology and legal medicine. Statistical models can effectively provide reconstructions together with statistical precision. In our applications, patient-specific meshes of the skull and the mandible are high-density meshes, extracted from 3D CT scans. All our patient-specific meshes are registrated in a subject-shared reference system using our 3D-to-3D elastic matching algorithm. Registration is based upon the minimization of a distance between the high density mesh and a shared low density mesh, defined on the vertexes, in a multi resolution approach. A Principal Component analysis is performed on the normalised registrated data to build a statistical linear model of the skull and mandible shape variation. The accuracy of the reconstruction is under the millimetre in the shape...

  13. Preoperative MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe in epileptic patients

    International Nuclear Information System (INIS)

    MR-based volume measurements of the anterior temporal lobe and hippocampal formation were performed in 36 patients who subsequently underwent surgery for medically refractory temporal lobe epilepsy. Seizure lateralization was based on standard clinical and electroencephalographic criteria. No surgical pathologic specimens contained structural lesions; epilepsy in these patients was therefore presumably due to mesial sclerosis. The right-minus-left hippocampal formation volume difference was greater than 0 in all 20 patients operated on the left side and less than 0 in all 16 patients operated on the right side. This difference completely separated the two surgical groups, while the same measurement in a group of 35 normal controls fell between the two surgical groups. Measurements of the anterior temporal to be showed a similar trend but incompletely separated controls, right- and left-sided epileptics. These results suggest that in a significant percentage of cases, MR-based volume measurements correctly identify the unilateral hippocampal atrophy that is known to occur in cases of mesial temporal sclerosis

  14. Asymmetric activation of the anterior cerebral cortex in recipients of IRECA: preliminary evidence for the energetic effects of an intention-based treatment modality on human neurophysiology.

    OpenAIRE

    Pike, C.; Vernon, D.; Hald, L.

    2014-01-01

    Objectives: Neurophysiologic studies of mindfulness link the health benefits of meditation to activation of the left-anterior cerebral cortex. The similarity and functional importance of intention and attentional stance in meditative and biofield therapeutic practices suggest that modulation of recipient anterior asymmetric activation may mediate the energetic effects of intention-based biofield treatments as well. The aim of the current study was to test this hypothesis by using a treatment ...

  15. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population

    Directory of Open Access Journals (Sweden)

    Jarvik Jeffrey G

    2011-09-01

    Full Text Available Abstract Background- Prior studies that have concluded that disk degeneration uniformly precedes facet degeneration have been based on convenience samples of individuals with low back pain. We conducted a study to examine whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observations of degeneration in a community-based population. Methods- 361 participants from the Framingham Heart Study were included in this study. The prevalences of anterior vertebral structure degeneration (disk height loss and posterior vertebral structure degeneration (facet joint osteoarthritis were characterized by CT imaging. The cohort was divided into the structural subgroups of participants with 1 no degeneration, 2 isolated anterior degeneration (without posterior degeneration, 3 combined anterior and posterior degeneration, and 4 isolated posterior degeneration (without anterior structure degeneration. We determined the prevalence of each degeneration pattern by age group Results- As the prevalence of the no degeneration and isolated anterior degeneration patterns decreased with increasing age group, the prevalence of the combined anterior/posterior degeneration pattern increased. 22% of individuals demonstrated isolated posterior degeneration, without an increase in prevalence by age group. Isolated posterior degeneration was most common at the L5-S1 and L4-L5 spinal levels. In multivariate analyses, disk height loss was independently associated with facet joint osteoarthritis, as were increased age (years, female sex, and increased BMI (kg/m2, but not smoking. Conclusions- The observed epidemiology of lumbar spinal degeneration in the community-based population is consistent with an ordered progression beginning in the anterior structures, for the majority of individuals. However, some individuals demonstrate atypical patterns of degeneration, beginning in the posterior joints. Increased age and BMI

  16. Characteristics of gunshot wounds in the skull.

    Science.gov (United States)

    Quatrehomme, G; Işcan, M Y

    1999-05-01

    The analysis of trauma to the skeleton is an important aspect of forensic case work, but most pathology references devote limited attention to this topic. This paper describes various aspects of gunshot wounds, including entrance and exit patterns, angle and path, range of fire and velocity, and caliber of the bullet, based on observations of a series of known cases. Skeletal remains of 21 victims of gunshot wounds were studied. In most cases, there was documentation of the investigation, autopsy, and victim's identity. Each case was analyzed in terms of wound location, shape, size and exit/entry surface area ratio, beveling, and direction of shooting Skull entry wounds were most often round or oval. Unusual shapes were observed in bones like the mandible and mastoid process, but were also found to be triangular, nearly rectangular or irregular. Tunneling was observed in the mastoid process. The expected internal beveling was obvious in all but one skull. External beveling of an entry wound was only observed in one case (parietal bone). Exit wounds were roughly round, oval, square, and rectangular and were always more irregular than entry wounds. External beveling of exit wounds was observed in most vault bones, but there was none in the orbit, maxilla, greater wing of the sphenoid, temporal, or left occipital bone. Tangential gunshot wounds were seen in a mastoid process, zygomatic process, mandibular ramus and condyle, and occipital condyle. Most of the exit to entry surface area ratios (cm2) varied from 1.4 to 2.0. In four cases the ratio indicated that entrances were larger than exists. In conclusion, understanding of gunshot wound characteristics is an important matter to interpret distance, velocity, direction and sometimes caliber size. Assessment of this nature of gunshot wounds helps reconstruct events surrounding the death. PMID:10408112

  17. A small skull from Flores dated to the 20th century

    DEFF Research Database (Denmark)

    Villa, Chiara; Persson, Liselott; Alexandersen, Verner;

    2012-01-01

    National Museum in Copenhagen. The "Copenhagen Flores" (CF) male skull is radiocarbon-dated and of modern age. The cranium is small, but larger than e.g. Liang Bua skull (LB1) in every measurement. The (CT-scan based) cranial capacity of 1258 ml is normal for modern humans, but somewhat lower than values...... from the middle or upper Palaeolithics. The metric cranial data analysed in FORDISC, characterize the skull as a male Vietnamese rather than a Chinese or White individual. Tooth morphology shows the sundadont pattern and tooth size corresponds to that of teeth from Bali, Java and Malayan Orang Asli...

  18. Broadband acoustic properties of a murine skull

    Science.gov (United States)

    Estrada, Héctor; Rebling, Johannes; Turner, Jake; Razansky, Daniel

    2016-03-01

    It has been well recognized that the presence of a skull imposes harsh restrictions on the use of ultrasound and optoacoustic techniques in the study, treatment and modulation of the brain function. We propose a rigorous modeling and experimental methodology for estimating the insertion loss and the elastic constants of the skull over a wide range of frequencies and incidence angles. A point-source-like excitation of ultrawideband acoustic radiation was induced via the absorption of nanosecond duration laser pulses by a 20 μm diameter microsphere. The acoustic waves transmitted through the skull are recorded by a broadband, spherically focused ultrasound transducer. A coregistered pulse-echo ultrasound scan is subsequently performed to provide accurate skull geometry to be fed into an acoustic transmission model represented in an angular spectrum domain. The modeling predictions were validated by measurements taken from a glass cover-slip and ex vivo adult mouse skulls. The flexible semi-analytical formulation of the model allows for seamless extension to other transducer geometries and diverse experimental scenarios involving broadband acoustic transmission through locally flat solid structures. It is anticipated that accurate quantification and modeling of the skull transmission effects would ultimately allow for skull aberration correction in a broad variety of applications employing transcranial detection or transmission of high frequency ultrasound.

  19. Relationship between the anterior forebrain mesocircuit and the default mode network in the structural bases of disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Nicholas D. Lant

    2016-01-01

    Full Text Available The specific neural bases of disorders of consciousness (DOC are still not well understood. Some studies have suggested that functional and structural impairments in the default mode network may play a role in explaining these disorders. In contrast, others have proposed that dysfunctions in the anterior forebrain mesocircuit involving striatum, globus pallidus, and thalamus may be the main underlying mechanism. Here, we provide the first report of structural integrity of fiber tracts connecting the nodes of the mesocircuit and the default mode network in 8 patients with DOC. We found evidence of significant damage to subcortico-cortical and cortico-cortical fibers, which were more severe in vegetative state patients and correlated with clinical severity as determined by Coma Recovery Scale—Revised (CRS-R scores. In contrast, fiber tracts interconnecting subcortical nodes were not significantly impaired. Lastly, we found significant damage in all fiber tracts connecting the precuneus with cortical and subcortical areas. Our results suggest a strong relationship between the default mode network – and most importantly the precuneus – and the anterior forebrain mesocircuit in the neural basis of the DOC.

  20. The Nondestructive Determination of the Aluminum Content in Pressed Skulls of Aluminum Dross

    Science.gov (United States)

    Kevorkijan, Varuzan; Škapin, Srečo Davor; Kovačec, Uroš

    2013-02-01

    prediction of the amount of free aluminum in pressed skulls w Al, based on nondestructive measurement of the density ρ of the pressed skulls. The pressed skulls density is measured by a fully automatic gas displacement pyknometer with a working volume large enough to enable the insertion of the whole pressed skull sample. An additional integral part of this methodology is the set of experimentally determined linear graphs w Al- ρ, plotted in advance for all classes of pressed skulls existing in the plant, from the experimentally collected data on pressed skulls density and aluminum recovery by melting. After selecting the proper graph w Al- ρ, which is usually performed on an aluminum alloy basis, the pyknometric measured density of the pressed skulls can be routinely related to the aluminum content sought, within a relative error of ±5%.

  1. A Study for Establishment of Diagnostic Reference Level of Patient Dose in Skull Radiography

    International Nuclear Information System (INIS)

    Ionizing radiation is most widely used for X-Ray examination . among all artificial radiation exposure, it takes up the largest proportion. Even in Korea, the medical exposure by diagnostic X-Ray examination takes up 17.4% of all radiation exposure. It takes up 92% even in artificial radiation exposure. There were 111,567 cases X-Ray radiography for skull diagnosis in 2007, which is 3% annual increase since 2004. Thus, It is need to establish the diagnostic reference level and the medical facilities as a diagnostic reference level to optimize radiation protection of the patients and to reduce the doses of X-ray. In this paper, we survey patient dose on skull radiography - collected from 114 medical facilities nationwide by using human phantom and glass dosimeter. When the patient dose for the skull radiography was measured and evaluated to establish the diagnostic reference level, 2.23 mGy was established for posterior-anterior imaging and 1.87 mGy for lateral imaging was established. The posterior-anterior skull radiography entrance surface dose of 2.23 is less than the guidance level of 5 mGy from the global organizations such as World Health Organization (WHO) and International Atomic Energy Agency (IAEA), and 1.87 mGy for the lateral skull imaging is less than the guidance level of 3 mGy, which is guided by the global organizations such as World Health Organization (WHO) and International Atomic Energy Agency (IAEA)

  2. Functional Imaging of Human Vestibular Cortex Activity Elicited by Skull Tap and Auditory Tone Burst

    Science.gov (United States)

    Noohi, F.; Kinnaird, C.; Wood, S.; Bloomberg, J.; Mulavara, A.; Seidler, R.

    2016-01-01

    The current study characterizes brain activation in response to two modes of vestibular stimulation: skull tap and auditory tone burst. The auditory tone burst has been used in previous studies to elicit either the vestibulo-spinal reflex (saccular-mediated colic Vestibular Evoked Myogenic Potentials (cVEMP)), or the ocular muscle response (utricle-mediated ocular VEMP (oVEMP)). Some researchers have reported that air-conducted skull tap elicits both saccular and utricle-mediated VEMPs, while being faster and less irritating for the subjects. However, it is not clear whether the skull tap and auditory tone burst elicit the same pattern of cortical activity. Both forms of stimulation target the otolith response, which provides a measurement of vestibular function independent from semicircular canals. This is of high importance for studying otolith-specific deficits, including gait and balance problems that astronauts experience upon returning to earth. Previous imaging studies have documented activity in the anterior and posterior insula, superior temporal gyrus, inferior parietal lobule, inferior frontal gyrus, and the anterior cingulate cortex in response to different modes of vestibular stimulation. Here we hypothesized that skull taps elicit similar patterns of cortical activity as the auditory tone bursts, and previous vestibular imaging studies. Subjects wore bilateral MR compatible skull tappers and headphones inside the 3T GE scanner, while lying in the supine position, with eyes closed. Subjects received both forms of the stimulation in a counterbalanced fashion. Pneumatically powered skull tappers were placed bilaterally on the cheekbones. The vibration of the cheekbone was transmitted to the vestibular system, resulting in the vestibular cortical response. Auditory tone bursts were also delivered for comparison. To validate our stimulation method, we measured the ocular VEMP outside of the scanner. This measurement showed that both skull tap and auditory

  3. Contribution of skull roentgenograms to pediatric diagnoses

    International Nuclear Information System (INIS)

    The place of roentgenograms of the skull has changed substantially over the last tow decades. Skull roentgenograms remain valuable for studying deformities involving all or part of the cranial vault, particularly plagiocephaly and craniosynostosis. They provide little information on the contents of the skull, which can be investigated noninvasively using computed tomography, magnetic resonance imaging, and, in infants, ultrasonography. The 1990 consensus panel concluded that patients with head injury should be evaluated mainly on the basis of clinical criteria and that the contribution of roentgenograms is minimal in this setting. In some central nervous system disorders, roentgenograms of the skull can be of use secondarily to look for calcifications or osteolysis. (authors). 10 refs., 1 figs., 1 tab

  4. Prediction and near-field observation of skull-guided acoustic waves

    OpenAIRE

    Estrada, Héctor; Rebling, Johannes; Razansky, Daniel

    2016-01-01

    Ultrasound waves propagating in water or soft biological tissue are strongly reflected when encountering the skull, which limits the use of ultrasound-based techniques in transcranial imaging and therapeutic applications. Current knowledge on the acoustic properties of the cranial bone is restricted to far-field observations, leaving its near-field properties unexplored. We report on the existence of skull-guided acoustic waves, which was herein confirmed by near-field measurements of optoaco...

  5. Skull fracture and the diagnosis of abuse.

    OpenAIRE

    Hobbs, C J

    1984-01-01

    Eighty nine children under 2 years of age with skull fracture were studied retrospectively--29 children with definite non-accidental injury serially recorded by the Departments of Paediatrics and Forensic Medicine, and 60 children consecutively admitted to hospital with skull fractures after accidents. There were 20 deaths including 19 among abused children. Multiple injuries and an inadequate history assisted in diagnosing abuse. Fracture characteristics found considerably more often in abus...

  6. The 'lamellated' skull in β-thalassaemia

    International Nuclear Information System (INIS)

    The skull in homozygous β-thalassaemia may present several abnormalities, such as osteopenia, widening of the diploic space, and a 'hair-on-end' appearance. In some cases it presents also a particular stratified appearance caused by a variable number of osseous lamellae, parallel with the inner table. This 'lamellated skull' was observed in 16 out of 150 patients affected by the disease (10.6%). (orig./GDG)

  7. 导航技术在颅底-颞下区肿瘤手术中的应用%Application of computer-aided design and navigation technology in skull base and infratemporal fossa tumor surgery

    Institute of Scientific and Technical Information of China (English)

    郭玉兴; 彭歆; 刘筱菁; 张雷; 俞光岩; 郭传殡

    2013-01-01

    Objective To evaluate the application of computer-aided design and navigation technology in skull base and infratemporal fossa tumor surgery and to analyze its advantages and disadvantages.Methods Twenty-nine cases with tumor of skull base and infratemporal fossa were treated with computer-aided design and navigation surgery.The Parameters of age,gender,primary or recurrent tumor,tumor nature and surgical approach were recorded.Results En bloc resection was performed in 20 cases and subtotal resection in 9 cases.The margin status was negative margin in 8 cases,near-tumor margin in 17 cases and positive resection margin in 4 cases.Postoperative complication rate was 14% (4/29).During the follow-up period,2 benign cases recurred.In the malignant group,there were 7 cases of recurrence,2 cases of metastasis and 3 deaths.The 5-year overall survival and progression-free survival rate were 69% and 40% respectively.Conclusions Navigation technology can enhance the confidence of the surgeons and operation safety in handling malignant tumors in skull base and infratemporal fossa.%目的 评价计算机辅助设计导航技术在颅底-颞下区肿瘤手术中的应用价值.方法 对29例颅底-颞下区肿瘤患者行计算机辅助手术方案设计及术中导航.记录患者的年龄、性别、肿瘤原发或复发、肿瘤性质及手术入路.应用SPSS 13.0软件计算生存率.结果 肿瘤完全切除20例、近全切除7例、次全切除2例;切除方式:整块切除20例、分块切除9例;切缘状态:阴性切缘8例、近肿瘤切除17例、阳性切缘4例.术后并发症发生率为14%(4/29).随访期内良性肿瘤复发2例.恶性肿瘤复发7例、转移2例、死亡3例,恶性肿瘤5年总生存率和无进展生存率分别为69%和40%.结论 计算机辅助设计导航技术可提高颅底-颞下区外科操作的手术安全性.

  8. Imaging basilar skull fractures in the horse: a review

    International Nuclear Information System (INIS)

    Due to the complex nature of the anatomy of the equine head, superimposition of numerous structures, and poor soft tissue differentiation, radiography may be of limited value in the diagnosis of basilar skull fractures. However, in many horses radiographic changes such as soft tissue opacification of the guttural pouch region, irregular bone margination at the sphenooccipital line, attenuation of the nasopharynx, ventral displacement of the dorsal pharyngeal wall and the presence of irregularly shaped bone fragments in the region of the guttural pouches are suggestive of a fracture of the skull base. These findings in conjunction with physical examination findings and historical information may lead to a presumptive diagnosis of a fracture. When available and when the patient will accommodate the equipment, computed tomography may give a definitive diagnosis owing to its superior resolution and differentiation of soft tissue structures

  9. Dental development of the Taung skull from computerized tomography.

    Science.gov (United States)

    Conroy, G C; Vannier, M W

    Just over 60 years ago, Dart's description and analysis of the Taung child's skull triggered an intellectual revolution about human origins. Recently, several authors have suggested that one of the most significant hominid-like traits of australopithecines, delayed maturation, may not after all be valid. This is a radical departure from Mann's classic study of australopithecine maturation and palaeodemography based on dental eruption patterns. The resolution of this debate has important implications for the history of the biological and social evolution of the human species. In view of the controversies generated by recent studies, and particularly because the Taung skull is the type specimen of Australopithecus africanus, we have investigated the relevant anatomy of the Taung 'child' using computerized tomography. We conclude that the Taung 'child' shows some important dental maturational affinities with great apes, although as Dart noted, other hominid-like features are clearly present. PMID:3116435

  10. Human skulls with turquoise inlays: pre hispanic origin or replicas?

    International Nuclear Information System (INIS)

    The lack of archaeological context determining if the manufacture of two human skulls adorned with turquoise inlays have pre-Columbian origin or not (replicas), led to perform other studies. Under these conditions, besides orthodox methodology commonly used to assign chronology and cultural aspects as form, style, decoration, iconography, etc., it was necessary to obtain more results based on the use of characterization techniques. The techniques employed were Scanning Electron Microscopy (SEM), X-Ray Energy Dispersive Spectroscopy (EDS), Transmission Electron Microscopy (TEM) and Fourier Transform Infrared Spectroscopy (FTIR), in order to determine the manufacture techniques and chemical composition of the materials used for the cementant. SEM analysis showed the presence of zones composed by Ca, O, C and Al. In some cases Mg, Cl, Fe and Pb were identified. High concentration of Cu was present in all samples, due to residues of turquoise inlays (CuAI6(PO4)4(OH)8(H2O)4) with which the skulls were decorated. In the cementant was identified the Ca as base element of the cementant, as well as particles < 100 nm with irregular morphology and other amorphous zones. FTIR spectrums indicated the presence of organic substances that could be used as agglutinating in the cementant. The current work shows a progress identifying involved techniques in the manufacturing of two human skulls with turquoise inlays. (Author)

  11. Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Bonneville, Fabrice; Chiras, Jacques [Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Savatovsky, Julien [Adolphe de Rothschild Foundation, Department of Radiology, Paris (France)

    2007-11-15

    Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions responsible for cerebellopontine angle (CPA) syndrome. However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion- and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion's site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Non-enhancing extra-axial CPA masses are cystic (epidermoid cyst, arachnoid cyst, neurenteric cyst) or contain fat (dermoid cyst, lipoma). Tumours can also extend into the CPA by extension from the skull base (paraganglioma, chondromatous tumours, chordoma, cholesterol granuloma, endolymphatic sac tumour). Finally, brain stem or ventricular tumours can present with a significant exophytic component in the CPA that may be difficult to differentiate from an extra-axial lesion (lymphoma, hemangioblastoma, choroid plexus papilloma, ependymoma, glioma, medulloblastoma, dysembryoplastic neuroepithelial tumour). (orig.)

  12. Reproducibility of imaging skull anatomic landmarks utilizing three-dimensional computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Sugawara, Yasushi; Harii, Kiyonori (Tokyo Univ. (Japan). Faculty of Medicine); Hirabayashi, Shinichi

    1994-05-01

    The study investigated the reproducibility of locating specific anatomic landmarks, utilizing computed tomography (CT), for the purpose of assigning accurate coordinates on the skull. Three-dimensional (3-D) CT data, obtained by scanning a dry adult skull, were processed using a multi-planar reconstruction (MPR) system. Each landmark was identified five times by the same technician, and the average distances between points identifying the same landmark were calculated. The 15 landmarks studied were the infra-orbital foramina, the external auditory meatus, the foramina rotundum, the foramina ovale, the optic canals, anterior crinoid processes, anterior nasal spine, crista galli, and the sella turcica. Three additional artificial markers placed in occlusal dental splints were also examined. The crinoid processes were identified with the highest degree of accuracy. The crista galli and optic canals were also located with reproducible results. The standard deviation calculated from the fine attempts to locate the artificial markers was smaller than that calculated from attempts to identify any of the landmarks. This implies that coordinates on the craniofacial bones should be defined using artificial markers rather than bony landmarks. Artificial markers placed in occlusal dental splints easily can be applied clinically. Complicated facial bone contours should be analyzed mathematically. In clinical setting, these points were found to be reproducible in 15 bony landmarks on the skull. (N.K.).

  13. Reproducibility of imaging skull anatomic landmarks utilizing three-dimensional computed tomography

    International Nuclear Information System (INIS)

    The study investigated the reproducibility of locating specific anatomic landmarks, utilizing computed tomography (CT), for the purpose of assigning accurate coordinates on the skull. Three-dimensional (3-D) CT data, obtained by scanning a dry adult skull, were processed using a multi-planar reconstruction (MPR) system. Each landmark was identified five times by the same technician, and the average distances between points identifying the same landmark were calculated. The 15 landmarks studied were the infra-orbital foramina, the external auditory meatus, the foramina rotundum, the foramina ovale, the optic canals, anterior crinoid processes, anterior nasal spine, crista galli, and the sella turcica. Three additional artificial markers placed in occlusal dental splints were also examined. The crinoid processes were identified with the highest degree of accuracy. The crista galli and optic canals were also located with reproducible results. The standard deviation calculated from the fine attempts to locate the artificial markers was smaller than that calculated from attempts to identify any of the landmarks. This implies that coordinates on the craniofacial bones should be defined using artificial markers rather than bony landmarks. Artificial markers placed in occlusal dental splints easily can be applied clinically. Complicated facial bone contours should be analyzed mathematically. In clinical setting, these points were found to be reproducible in 15 bony landmarks on the skull. (N.K.)

  14. All the Information the Neonate and Infant Skull

    Directory of Open Access Journals (Sweden)

    M. Bajoghli

    2008-01-01

    Full Text Available The art of skull interpretation slowly being lost and trainees in radiology see few plane film of skull. However, skull radiography still provides significant information that is helpful in finding pathologic conditions. Abnormality of skull may be reflected as variation in density, size and shape of the skull, as well as skull defect. Skull dysplasia may manifest as decreased calvarial density (hypophosphatasia, osteogenesis imferfecta, or increased calvarial density (osteopetrosis, or facial increase in density (frontometaphyseal dysplasia. Diffusely decreased or increased clavarial density is more associated with process that affects entire skull. Decrease density of cranial vault at birth seen more in torch and fetal alcoholic. Macrocephaly may be due to skeletal sysplasia, or hydrocephalus. The aim of this review is to evaluate plane film of skull in neonate and infants.

  15. Functional relationship between skull form and feeding mechanics in Sphenodon, and implications for diapsid skull development.

    Directory of Open Access Journals (Sweden)

    Neil Curtis

    Full Text Available The vertebrate skull evolved to protect the brain and sense organs, but with the appearance of jaws and associated forces there was a remarkable structural diversification. This suggests that the evolution of skull form may be linked to these forces, but an important area of debate is whether bone in the skull is minimised with respect to these forces, or whether skulls are mechanically "over-designed" and constrained by phylogeny and development. Mechanical analysis of diapsid reptile skulls could shed light on this longstanding debate. Compared to those of mammals, the skulls of many extant and extinct diapsids comprise an open framework of fenestrae (window-like openings separated by bony struts (e.g., lizards, tuatara, dinosaurs and crocodiles, a cranial form thought to be strongly linked to feeding forces. We investigated this link by utilising the powerful engineering approach of multibody dynamics analysis to predict the physiological forces acting on the skull of the diapsid reptile Sphenodon. We then ran a series of structural finite element analyses to assess the correlation between bone strain and skull form. With comprehensive loading we found that the distribution of peak von Mises strains was particularly uniform throughout the skull, although specific regions were dominated by tensile strains while others were dominated by compressive strains. Our analyses suggest that the frame-like skulls of diapsid reptiles are probably optimally formed (mechanically ideal: sufficient strength with the minimal amount of bone with respect to functional forces; they are efficient in terms of having minimal bone volume, minimal weight, and also minimal energy demands in maintenance.

  16. Solitary skull metastasis as the first symptom of hepatocellular carcinoma: case report and literature review

    Directory of Open Access Journals (Sweden)

    Guo X

    2014-04-01

    in the calvaria site were more frequent than those that occurred in the skull base and facial skeleton. This may be worthy of further investigation in the future.Keywords: hepatocellular carcinoma, skull metastasis, bone metastasis, positron emission tomography

  17. Skull shapes of the Lissodelphininae: radiation, adaptation and asymmetry.

    Science.gov (United States)

    Galatius, Anders; Goodall, R Natalie P

    2016-06-01

    Within Delphinidae, the sub-family Lissodelphininae consists of 8 Southern Ocean species and 2 North Pacific species. Lissodelphininae is a result of recent phylogenetic revisions based on molecular methods. Thus, morphological radiation within the taxon has not been investigated previously. The sub-family consists of ecologically diverse groups such as (1) the Cephalorhynchus genus of 4 small species inhabiting coastal and shelf waters, (2) the robust species in the Lagenorhynchus genus with the coastal La. australis, the offshore La. cruciger, the pelagic species La. obscurus and La. obliquidens, and (3) the morphologically aberrant genus Lissodelphis. Here, the shapes of 164 skulls from adults of all 10 species were compared using 3-dimensional geometric morphometrics. The Lissodelphininae skulls were supplemented by samples of Lagenorhynchus albirostris and Delphinus delphis to obtain a context for the variation found within the subfamily. Principal components analysis was used to map the most important components of shape variation on phylogeny. The first component of shape variation described an elongation of the rostrum, lateral and dorsoventral compression of the neurocranium and smaller temporal fossa. The two Lissodelphis species were on the high extreme of this spectrum, while Lagenorhynchus australis, La. cruciger and Cephalorhynchus heavisidii were at the low extreme. Along the second component, La. cruciger was isolated from the other species by its expanded neurocranium and concave facial profile. Shape variation supports the gross phylogenetic relationships proposed by recent molecular studies. However, despite the great diversity of ecology and external morphology within the subfamily, shape variation of the feeding apparatus was modest, indicating a similar mode of feeding across the subfamily. All 10 species were similar in their pattern of skull asymmetry, but interestingly, two species using narrowband high frequency clicks (La. cruciger and C

  18. Design and Manufacturing of a Custom Skull Implant

    Directory of Open Access Journals (Sweden)

    Juan F.I. Saldarriaga

    2011-01-01

    Full Text Available Problem statement: Cranioplasty is defined as a neurosurgical procedure to cover an injured bone in the skull. This procedure is carried out in order to protect and restore intracranial structures and to restore the appearance and psychological stability of the patient. Advances in medical imaging, such as MRI and CT, have allowed the 3D reconstruction of anatomical structures for several medical applications, including the design of custom-made implants. This study describes the methodology used to design a custom-made cranial implant for a 13-year-old patient who suffered a lesion in the left frontoparietal region of the skull caused by a fall. Approach: The design of the implant was based on the 3D reconstruction of the skull of the patient, obtained by a CT scan, using Rapid Form® 2006. Once the preliminary design was completed, 3D models of the injured region of the skull and of the implant were fabricated in a Rapid Prototyping (RP machine using Fused Deposition Modeling Technology (FDM with the purpose of functionally and dimensionally validating the implant. Subsequently, the implant was fabricated using a 1.2-mm-thick Titanium Alloy (Ti6Al4V plate. Results: The prosthesis was successfully implanted. The surgical time was 85% shorter than that for the same type of surgery in which standard commercial implants and titanium meshes are used. This decrease in surgery time is primarily the result of eliminating the need for trial and error procedures to achieve a good fit for the implant. Finally, the appearance of the patient was restored, allowing the patient to safely perform daily activities. Conclusion: The use of 3D reconstruction techniques from medical images reduces the possibility of errors during surgery, improves fit and provides better implant stability. The use of 3D models designed in RP proved to be an effective practice in the design process.

  19. Examining the feasibility of a Microsoft Kinect ™ based game intervention for individuals with anterior cruciate ligament injury risk.

    Science.gov (United States)

    Zhiyu Huo; Griffin, Joseph; Babiuch, Ryan; Gray, Aaron; Willis, Bradley; Marjorie, Skubic; Shining Sun

    2015-08-01

    We describe a feasibility study in which the Microsoft Kinect is used for a game-based exercise to strengthen posterior chain muscles which are often weak in those at high risk of anterior cruciate ligament (ACL) injury. In the game, subjects perform a single posterior chain strengthening exercise. The game uses a side-scrolling video display driven by a hip abduction exercise while a player lies down on the floor. Leg lifts beyond a predetermined angle trigger the jumping action of an animated tiger. We describe the scene and game control, which uses depth images from the Kinect. Although Kinect-based skeletal data are used for many games, the skeletal model does not yield good estimates for positions on the floor. Our proposed system uses multiple leg angle estimators for different angle regions to recognize the player lying down and capture the angle between two legs. We conducted an experiment that validates our system with marker-based Vicon ground truth data. We also present results of an end-to-end test using the game, showing feasibility. PMID:26737918

  20. Creating physical 3D stereolithograph models of brain and skull.

    Directory of Open Access Journals (Sweden)

    Daniel J Kelley

    Full Text Available The human brain and skull are three dimensional (3D anatomical structures with complex surfaces. However, medical images are often two dimensional (2D and provide incomplete visualization of structural morphology. To overcome this loss in dimension, we developed and validated a freely available, semi-automated pathway to build 3D virtual reality (VR and hand-held, stereolithograph models. To evaluate whether surface visualization in 3D was more informative than in 2D, undergraduate students (n = 50 used the Gillespie scale to rate 3D VR and physical models of both a living patient-volunteer's brain and the skull of Phineas Gage, a historically famous railroad worker whose misfortune with a projectile tamping iron provided the first evidence of a structure-function relationship in brain. Using our processing pathway, we successfully fabricated human brain and skull replicas and validated that the stereolithograph model preserved the scale of the VR model. Based on the Gillespie ratings, students indicated that the biological utility and quality of visual information at the surface of VR and stereolithograph models were greater than the 2D images from which they were derived. The method we developed is useful to create VR and stereolithograph 3D models from medical images and can be used to model hard or soft tissue in living or preserved specimens. Compared to 2D images, VR and stereolithograph models provide an extra dimension that enhances both the quality of visual information and utility of surface visualization in neuroscience and medicine.

  1. Volumetric modulated arc therapy versus step-and-shoot intensity modulated radiation therapy in the treatment of large nerve perineural spread to the skull base: a comparative dosimetric planning study

    Energy Technology Data Exchange (ETDEWEB)

    Gorayski, Peter; Fitzgerald, Rhys; Barry, Tamara [Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland (Australia); Burmeister, Elizabeth [Nursing Practice Development Unit, Princess Alexandra Hospital and Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Queensland (Australia); Foote, Matthew [Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland (Australia); Diamantina Institute, University of Queensland, Brisbane, Queensland (Australia)

    2014-06-15

    Cutaneous squamous cell carcinoma with large nerve perineural (LNPN) infiltration of the base of skull is a radiotherapeutic challenge given the complex target volumes to nearby organs at risk (OAR). A comparative planning study was undertaken to evaluate dosimetric differences between volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in the treatment of LNPN. Five consecutive patients previously treated with IMRT for LNPN were selected. VMAT plans were generated for each case using the same planning target volumes (PTV), dose prescriptions and OAR constraints as IMRT. Comparative parameters used to assess target volume coverage, conformity and homogeneity included V95 of the PTV (volume encompassed by the 95% isodose), conformity index (CI) and homogeneity index (HI). In addition, OAR maximum point doses, V20, V30, non-target tissue (NTT) point max doses, NTT volume above reference dose, monitor units (MU) were compared. IMRT and VMAT plans generated were comparable for CI (P = 0.12) and HI (P = 0.89). VMAT plans achieved better V95 (P = < 0.001) and reduced V20 and V30 by 652 cubic centimetres (cc) (28.5%) and 425.7 cc (29.1%), respectively. VMAT increased MU delivered by 18% without a corresponding increase in NTT dose. Compared with IMRT plans for LNPN, VMAT achieved comparable HI and CI.

  2. Volumetric modulated arc therapy versus step-and-shoot intensity modulated radiation therapy in the treatment of large nerve perineural spread to the skull base: a comparative dosimetric planning study

    International Nuclear Information System (INIS)

    Cutaneous squamous cell carcinoma with large nerve perineural (LNPN) infiltration of the base of skull is a radiotherapeutic challenge given the complex target volumes to nearby organs at risk (OAR). A comparative planning study was undertaken to evaluate dosimetric differences between volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in the treatment of LNPN. Five consecutive patients previously treated with IMRT for LNPN were selected. VMAT plans were generated for each case using the same planning target volumes (PTV), dose prescriptions and OAR constraints as IMRT. Comparative parameters used to assess target volume coverage, conformity and homogeneity included V95 of the PTV (volume encompassed by the 95% isodose), conformity index (CI) and homogeneity index (HI). In addition, OAR maximum point doses, V20, V30, non-target tissue (NTT) point max doses, NTT volume above reference dose, monitor units (MU) were compared. IMRT and VMAT plans generated were comparable for CI (P = 0.12) and HI (P = 0.89). VMAT plans achieved better V95 (P = < 0.001) and reduced V20 and V30 by 652 cubic centimetres (cc) (28.5%) and 425.7 cc (29.1%), respectively. VMAT increased MU delivered by 18% without a corresponding increase in NTT dose. Compared with IMRT plans for LNPN, VMAT achieved comparable HI and CI

  3. Psychophysiological Working Mechanisms of Mindfulness-Based Cognitive Therapy: Functional Anterior Brain Asymmetry and Affective Style

    OpenAIRE

    Keune, Philipp

    2011-01-01

    Major Depressive Disorder (MDD) is one of the most frequent psychiatric disorders and is often not limited to a single depressive episode, but involves repeated relapses. Due to the frequent phenomenon of relapse, in recent years, research efforts in clinical psychology have focused on the development and refinement of maintenance psychotherapy, i.e. therapeutic interventions specifically designed to prevent depressive relapse. Mindfulness-Based Cognitive Therapy (MBCT) is a meditation-based ...

  4. Efficacy of a lutein-based dye (PhacodyneTM for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification

    Directory of Open Access Journals (Sweden)

    Lucas Monferrari Monteiro Vianna

    2014-06-01

    Full Text Available Objetivos: Avaliar a eficácia e eficiência de um novo corante à base de luteína para coloração da cápsula anterior durante cirurgia de facoemulsificação em humanos. Métodos: Vinte e cinco olhos de 25 pacientes foram operados por 25 cirurgiões diferentes que realizaram capsulorrexis circular contínua e facoemulsificação após coloração da cápsula anterior com corante à base de luteína. Um questionário avaliou a opinião dos cirurgiões sobre a eficácia do corante. Exames pós-operatórios foram realizados nos dias 1, 7 e 30 por meio de exame oftalmológico completo, topografia/ paquimetria e contagem de células endoteliais. Resultados: De acordo com o questionário aplicado, o corante facilitou a cirurgia em todos os olhos. A classificação da catarata de acordo com o LOCS III foi de 3,24 ± 1,12. A acuidade visual pré-operatória com melhor correção foi de 0,89 ± 0,59 (logMAR, passando a 0,23 ± 0,22 no pós-operatório. A pressão intraocular (PIO permaneceu estável e houve reação de câmara leve que desapareceu em todos os casos durante os primeiros 7 dias de pós-operatório. Não houve significância estatística comparando a paquimetria e PIO pré e pós-operatórios. Conclusão: O novo corante se mostrou eficiente e sem sinais de toxicidade ou efeitos adversos, após 30 dias, quando usado para auxiliar a cirurgia de facoemulsificação.

  5. Occlusion of the anterior cerebral artery after head trauma

    OpenAIRE

    2013-01-01

    Intracranial arterial occlusion is rarely encountered in association with head injury. Only six cases of traumatic occlusion of the anterior cerebral artery (ACA) have previously been reported. In this paper, the authors describe a case of a posttraumatic occlusion of ACA. A 35-year-old male presented to the emergency room with severe head injury. Computed tomography (CT) scan displayed diffuse brain swelling with multiple skull fractures. Follow up CT scan showed extensive cerebral infarctio...

  6. Cloverleaf skull associated with unusual skeletal anomalies

    International Nuclear Information System (INIS)

    A male infant which cloverleaf skull and multiple other birth defects born to unrelated, healthy, young parents is presented. Radiologic findings in addition to the cloverleaf skull configuration included short, wide clavicles, winged scapulae, unusual shapes of ribs with abnormal spacing between them and with prominent costovertebral junctions, and widely separated ischia. Ulnae appeared angular with probable fusion to the midportion of the radial bones bilaterally. There was polydactyly of the hands and feet with grossly abnormal metacarpal and metatarsal bones. Skeletal maturation was normal. Computed tomography of the skull showed dilated lateral and third ventricles as well as agenesis of the corpus callosum. The mother denies any teratogenic exposure during the pregnancy. The findings in this infant do not seem to fit into any previously described syndrome. (orig.)

  7. [Injury by skull osteolytic secundary syphilis].

    Science.gov (United States)

    Alessandro, Lucas; Camporro, Julieta Piar; Arakaki, Naomi; Orellana, Nora; Mora, Claudia Andrea

    2016-04-01

    Bone involvement of syphilis can be observed in tertiary and congenital syphilis. It is infrequent during the secondary stage. The skull is the most affected bone in secondary syphilis, and its most frequent form of presentation is proliferative osteitis. If the skull is affected, headache is usual and can be as intense as in meningitis. Osteolyitic lesions may be seen in complimentary imaging studies, with a moth eaten aspect. These lesions raise concern over a number of differential diagnoses, among which are infectious, inflammatory and neoplastic diseases. The definitive diagnosis is made by bone biopsy of the compromised bone. Molecular techniques in the affected tissues increases diagnostic performance. There is no standardized treatment protocol for syphilis since there are no guidelines available. We report a case of a 19 year old female, presenting with a unique osteolytic lesion in the skull due to secondary syphilis. PMID:27315003

  8. The first fossil skull of Alligator sinensis from the Pleistocene, Taiwan, with a paleogeographic implication of the species

    Science.gov (United States)

    Hsi-yin, Shan; Yen-nien, Cheng; Xiao-chun, Wu

    2013-06-01

    A nearly complete fossil skull of Alligatoridae from the Pleistocene, Penghu Channel, east of Taiwan, is reported. It can be referred to the most latest clade of Alligatorinae, which includes Alligator sinensis, Alligator mississippiensis and Alligator mefferdi, on the basis of the following features: the splenial is excluded from the mandibular symphysis; the anterior tip of the splenial passes dorsal to the Meckelian groove; and the mandible is gently curved between the fourth alveoli and the mid dentary. It differs from A. mississippiensis and A. mefferdi mainly in the following characters: the breadth between the supratemporal fenestrae is approximately equal to the interorbital width, the snout is about half the length of the skull; and the anterior part of the snout is subtriangular in dorsal view. These features suggest that the Penghu alligator is most probably referable to A. sinensis. This is the only fossil skull of A. sinensis known. The discovery of the skull in Penghu Channel not only provides the first solid fossil evidence to indicate that the geological distribution of A. sinensis extended farther southeast than the historical/archeological range of the species but also adds new information on the biodiversity of the Penghu fauna.

  9. Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

    Directory of Open Access Journals (Sweden)

    Daniella Borges Machado

    2014-10-01

    Full Text Available INTRODUCTION: The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children. METHODS: A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010. The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0 with a 95% level of significance. RESULTS: The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02. Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03. CONCLUSION: There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite.

  10. Adaptation of proton total dose with respect to dosimetric parameters within the frame of treatment of skull base or upper cervical spine chordomas; Adaptation de la dose totale de protons en fonction des parametres dosimetriques dans le cadre du traitement des chordomes de la base du crane et du rachis cervical haut

    Energy Technology Data Exchange (ETDEWEB)

    Hemery, C.G.; Mazeron, J.J.; Feuvret, L. [Groupe hospitalier Pitie-Salpetriere (AP-HP), 75 - Paris (France); Calugaru, V.; Bolle, S.; Habrand, J.L.; Datcharty, J.; Alapetite, C.; Dendale, R.; Feuvret, L. [Institut Curie-Centre de protontherapie d' Orsay, 91 (France); Habrand, J.L.; Datcharty, J. [Institut Gustave-Roussy, 94 - Villejuif (France); Noel, G. [Centre Paul-Strauss, 67 - Strasbourg (France)

    2010-10-15

    The authors report the study of the feasibility of a photon-proton irradiation protocol with a dose adaptation with respect to dosimetric factors for patients suffering form a skull base and upper cervical spine chordoma. Sixty patients have been treated between May 2006 and June 2008 with a combination of high energy photons and protons. As five tumours have locally relapsed and one at distance, the authors comment the local control rates, the number of attained cranial nerves, the value of the macroscopic tumour volume, the survival rate without relapse in terms of multifactorial of uni-factorial analysis. Short communication

  11. Network Profiles of the Dorsal Anterior Cingulate and Dorsal Prefrontal Cortex in Schizophrenia During Hippocampal-Based Associative Memory.

    Science.gov (United States)

    Woodcock, Eric A; Wadehra, Sunali; Diwadkar, Vaibhav A

    2016-01-01

    Schizophrenia is a disorder characterized by brain network dysfunction, particularly during behavioral tasks that depend on frontal and hippocampal mechanisms. Here, we investigated network profiles of the regions of the frontal cortex during memory encoding and retrieval, phases of processing essential to associative memory. Schizophrenia patients (n = 12) and healthy control (HC) subjects (n = 10) participated in an established object-location associative memory paradigm that drives frontal-hippocampal interactions. Network profiles were modeled of both the dorsal prefrontal (dPFC) and the dorsal anterior cingulate cortex (dACC) as seeds using psychophysiological interaction analyses, a robust framework for investigating seed-based connectivity in specific task contexts. The choice of seeds was motivated by previous evidence of involvement of these regions during associative memory. Differences between patients and controls were evaluated using second-level analyses of variance (ANOVA) with seed (dPFC vs. dACC), group (patients vs. controls), and memory process (encoding and retrieval) as factors. Patients showed a pattern of exaggerated modulation by each of the dACC and the dPFC during memory encoding and retrieval. Furthermore, group by memory process interactions were observed within regions of the hippocampus. In schizophrenia patients, relatively diminished modulation during encoding was associated with increased modulation during retrieval. These results suggest a pattern of complex dysfunctional network signatures of critical forebrain regions in schizophrenia. Evidence of dysfunctional frontal-medial temporal lobe network signatures in schizophrenia is consistent with the illness' characterization as a disconnection syndrome. PMID:27092063

  12. Phacoemulsification in anterior megalophthalmos.

    Science.gov (United States)

    Lee, Graham A; Hann, Joshua V; Braga-Mele, Rosa

    2006-07-01

    This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes. PMID:16857490

  13. Skull X-Rays for Head Injury

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-08-01

    Full Text Available The effect of abolishing skull X-rays on the rate of admission, use of computer tomography (CT, radiation dose per head injury, and detection of intracranial injuries was determined in patients, aged 1 to 14 years, presenting to the ED at Royal Hospital for Sick Children, Edinburgh, UK.

  14. Skull X-Rays for Head Injury

    OpenAIRE

    J Gordon Millichap

    2005-01-01

    The effect of abolishing skull X-rays on the rate of admission, use of computer tomography (CT), radiation dose per head injury, and detection of intracranial injuries was determined in patients, aged 1 to 14 years, presenting to the ED at Royal Hospital for Sick Children, Edinburgh, UK.

  15. Sex-diagnosis of human skulls

    NARCIS (Netherlands)

    Looze, de Ellen M.A.

    1996-01-01

    For 41 human skulls from the 19th century in the collection of the Zoological Museum Amsterdam the discriminant function score was calculated using a set of twelve variables in order to arrive at a best-as-possible sex-diagnosis. The function used was developed by Van Vark & Pasveer (1994). This led

  16. The oldest anatomical handmade skull of the world c. 1508: 'the ugliness of growing old' attributed to Leonardo da Vinci.

    Science.gov (United States)

    Missinne, Stefaan J

    2014-06-01

    The author discusses a previously unknown early sixteenth-century renaissance handmade anatomical miniature skull. The small, naturalistic skull made from an agate (calcedonia) stone mixture (mistioni) shows remarkable osteologic details. Dr. Saban was the first to link the skull to Leonardo. The three-dimensional perspective of and the search for the senso comune are discussed. Anatomical errors both in the drawings of Leonardo and this skull are presented. The article ends with the issue of physiognomy, his grotesque faces, the Perspective Communis and his experimenting c. 1508 with the stone mixture and the human skull. Evidence, including the Italian scale based on Crazie and Braccia, chemical analysis leading to a mine in Volterra and Leonardo's search for the soul in the skull are presented. Written references in the inventory of Salai (1524), the inventory of the Villa Riposo (Raffaello Borghini 1584) and Don Ambrogio Mazenta (1635) are reviewed. The author attributes the skull c. 1508 to Leonardo da Vinci. PMID:24853982

  17. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

    Energy Technology Data Exchange (ETDEWEB)

    Bendel, Paula; Koskenkorva, Paeivi; Vanninen, Ritva [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Koivisto, Timo; Aeikiae, Marja [Kuopio University Hospital and University of Kuopio, Department of Neurosurgery, Kuopio (Finland); Niskanen, Eini [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Physics, Kuopio (Finland); Koenoenen, Mervi [Kuopio University Hospital and University of Kuopio, Department of Clinical Radiology, Kuopio (Finland); Kuopio University Hospital and University of Kuopio, Department of Clinical Neurophysiology, Kuopio (Finland); Haenninen, Tuomo [Kuopio University Hospital and University of Kuopio, Department of Neurology, Kuopio (Finland)

    2009-11-15

    Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm. Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment. The comparisons between controls and either all patients (n=37) or the subgroup of surgically treated patients (n=17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment. Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms. (orig.)

  18. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

    International Nuclear Information System (INIS)

    Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm. Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment. The comparisons between controls and either all patients (n=37) or the subgroup of surgically treated patients (n=17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment. Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms. (orig.)

  19. A morphological analysis of the skull size and shape of Kerivoulinae (Chiroptera: Vespertilionidae) from Vietnam.

    Science.gov (United States)

    Nguyen, Son Truong; Motokawa, Masaharu; Oshida, Tatsuo; Endo, Hideki

    2016-02-01

    Southeast Asia is a region of high biodiversity, containing species of plants and animals that are yet to be discovered. In this region, bats of the subfamily Kerivoulinae are widespread and diverse with six species recorded in Vietnam. However, the taxonomy of the Kerivoulinae in Asia is complicated. In our study, we used diagnostic characters and multivariate analysis to determine morphological differences between the genera Kerivoula and Phoniscus. We showed that the two genera are distinguishable by the size of second upper incisors, the shape of skull, nasal sinus, canines, second upper and lower premolars. In addition, the two genera can be osteometrically separated by measurements of the braincase height, interorbital width and shape of anterior palatal emargination. Our data clearly revealed the morphological variations in the skull shape of Kerivoula hardwickii in Vietnam. This suggests a possible separation into three morphotypes, representing cryptic species supported by statistical differences with wide variation in skull shape, size and teeth. These results demonstrated Kerivoula hardwickii can be separated three subspecies, and the result will serve as the basis for the future assessment and classification of this group in Southeast Asia. PMID:26346743

  20. The Role of Skull Modeling in EEG Source Imaging for Patients with Refractory Temporal Lobe Epilepsy.

    Science.gov (United States)

    Montes-Restrepo, Victoria; Carrette, Evelien; Strobbe, Gregor; Gadeyne, Stefanie; Vandenberghe, Stefaan; Boon, Paul; Vonck, Kristl; Mierlo, Pieter van

    2016-07-01

    We investigated the influence of different skull modeling approaches on EEG source imaging (ESI), using data of six patients with refractory temporal lobe epilepsy who later underwent successful epilepsy surgery. Four realistic head models with different skull compartments, based on finite difference methods, were constructed for each patient: (i) Three models had skulls with compact and spongy bone compartments as well as air-filled cavities, segmented from either computed tomography (CT), magnetic resonance imaging (MRI) or a CT-template and (ii) one model included a MRI-based skull with a single compact bone compartment. In all patients we performed ESI of single and averaged spikes marked in the clinical 27-channel EEG by the epileptologist. To analyze at which time point the dipole estimations were closer to the resected zone, ESI was performed at two time instants: the half-rising phase and peak of the spike. The estimated sources for each model were validated against the resected area, as indicated by the postoperative MRI. Our results showed that single spike analysis was highly influenced by the signal-to-noise ratio (SNR), yielding estimations with smaller distances to the resected volume at the peak of the spike. Although averaging reduced the SNR effects, it did not always result in dipole estimations lying closer to the resection. The proposed skull modeling approaches did not lead to significant differences in the localization of the irritative zone from clinical EEG data with low spatial sampling density. Furthermore, we showed that a simple skull model (MRI-based) resulted in similar accuracy in dipole estimation compared to more complex head models (based on CT- or CT-template). Therefore, all the considered head models can be used in the presurgical evaluation of patients with temporal lobe epilepsy to localize the irritative zone from low-density clinical EEG recordings. PMID:26936594

  1. Ecomorphology of the eyes and skull in zooplanktivorous labrid fishes

    Science.gov (United States)

    Schmitz, L.; Wainwright, P. C.

    2011-06-01

    Zooplanktivory is one of the most distinct trophic niches in coral reef fishes, and a number of skull traits are widely recognized as being adaptations for feeding in midwater on small planktonic prey. Previous studies have concluded that zooplanktivores have larger eyes for sharper visual acuity, reduced mouth structures to match small prey sizes, and longer gill rakers to help retain captured prey. We tested these three traditional hypotheses plus two novel adaptive hypotheses in labrids, a clade of very diverse coral reef fishes that show multiple independent evolutionary origins of zooplanktivory. Using phylogenetic comparative methods with a data set from 21 species, we failed to find larger eyes in three independent transitions to zooplanktivory. Instead, an impression of large eyes may be caused by a size reduction of the anterior facial region. However, two zooplanktivores ( Clepticus parrae and Halichoeres pictus) possess several features interpreted as adaptations to zooplankton feeding, namely large lens diameters relative to eye axial length, round pupil shape, and long gill rakers. The third zooplanktivore in our analysis, Cirrhilabrus solorensis, lacks all above features. It remains unclear whether Cirrhilabrus shows optical specializations for capturing planktonic prey. Our results support the prediction that increased visual acuity is adaptive for zooplanktivory, but in labrids increases in eye size are apparently not part of the evolutionary response.

  2. Geographic variation and sexual dimorphism in the skull of the dusky dolphin, Lagenorhynchus obscurus (Gray, 1828)

    OpenAIRE

    Van Waerebeek, K.

    1993-01-01

    Variation in skulls of 415 dusky dolphins, Lagenorhynchus obscures, was studied based on 37 standard cranial measurements and meristic variables and 28 nonmetrical characters (NMC) by using both bivariate and multivariate analyses. Geographic variation was analysed in mature skulls from central Peru (N=189), Chile (N=22), New Zealand (N=47) and southwestern Africa (N=40). Advanced fusion in the frontal-supraoccipital suture is the most reliable (95% efficiency) cranial criterion of sexual mat...

  3. Neonatal skull depression unassociated with birth trauma

    International Nuclear Information System (INIS)

    With few exceptions, a depression of the calvaria in a neonate is caused by birth trauma and often is associated with fracture. Localized depression of the skull without trauma is rare, and such a case is reported here. The cause, complications, and treatment of this condition are briefly discussed. Computed tomography (CT) was useful in clinical management. Although sizable, the depression was not associated with neurologic features and disappeared spontaneously

  4. Skull metastasis from rectal gastrointestinal stromal tumours.

    Science.gov (United States)

    Gil-Arnaiz, Irene; Martínez-Trufero, Javier; Pazo-Cid, Roberto Antonio; Felipo, Francesc; Lecumberri, María José; Calderero, Verónica

    2009-09-01

    Gastrointestinal stromal tumours (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. Rectum localisation is infrequent for these neoplasms, accounting for about 5% of all cases. Distant metastases of GIST are also rare. We present a patient with special features: the tumour is localised in rectum and it has an uncommon metastatic site, the skull, implying a complex differential diagnosis approach. PMID:19776004

  5. Periorbital skull fractures in five horses

    International Nuclear Information System (INIS)

    Periorbital skull fractures were diagnosed in 5 horses, and were associated with ophthalmic complications including corneal ulceration, uveitis, and entrapment of the eye by retrobulbar bone fragments. Physical examination was of greater diagnostic use than radiography. Surgical repair was performed on all horses and was associated with a more favorable postoperative appearance in horses treated acutely; however, the cosmetic results were considered acceptable in all horses. Major postoperative complications were not observed

  6. Skull removal in MR images using a modified artificial bee colony optimization algorithm.

    Science.gov (United States)

    Taherdangkoo, Mohammad

    2014-01-01

    Removal of the skull from brain Magnetic Resonance (MR) images is an important preprocessing step required for other image analysis techniques such as brain tissue segmentation. In this paper, we propose a new algorithm based on the Artificial Bee Colony (ABC) optimization algorithm to remove the skull region from brain MR images. We modify the ABC algorithm using a different strategy for initializing the coordinates of scout bees and their direction of search. Moreover, we impose an additional constraint to the ABC algorithm to avoid the creation of discontinuous regions. We found that our algorithm successfully removed all bony skull from a sample of de-identified MR brain images acquired from different model scanners. The obtained results of the proposed algorithm compared with those of previously introduced well known optimization algorithms such as Particle Swarm Optimization (PSO) and Ant Colony Optimization (ACO) demonstrate the superior results and computational performance of our algorithm, suggesting its potential for clinical applications. PMID:25059256

  7. Prediction and near-field observation of skull-guided acoustic waves

    CERN Document Server

    Estrada, Héctor; Razansky, Daniel

    2016-01-01

    Ultrasound waves propagating in water or soft biological tissue are strongly reflected when encountering the skull, which limits the use of ultrasound-based techniques in transcranial imaging and therapeutic applications. Current knowledge on the acoustic properties of the cranial bone is restricted to far-field observations, leaving its near-field properties unexplored. We report on the existence of skull-guided acoustic waves, which was herein confirmed by near-field measurements of optoacoustically-induced responses in ex-vivo murine skulls immersed in water. Dispersion of the guided waves was found to reasonably agree with the prediction of a multilayered flat plate model. It is generally anticipated that our findings may facilitate and broaden the application of ultrasound-mediated techniques in brain diagnostics and therapy.

  8. AUTONOMOUS CT REPLACEMENT METHOD FOR THE SKULL PROSTHESIS MODELLING

    Directory of Open Access Journals (Sweden)

    Marcelo Rudek

    2015-12-01

    Full Text Available The geometric modeling of prosthesis is a complex task from medical and engineering viewpoint. A method based on CT replacement is proposed in order to circumvent the related problems with the missing information to modeling. The method is based on digital image processing and swarm intelligence algorithm. In this approach, a missing region on the defective skull is represented by curvature descriptors. The main function of the descriptors is to simplify the skull’s contour geometry; and they are defined from the Cubic Bezier Curves using a meta-heuristic process for parameter’s estimation. The Artificial Bee Colony (ABC optimization technique is applied in order to evaluate the best solution. The descriptors from a defective CT slice image are the searching parameters in medical image databases, and a similar image, i.e. with similar descriptors, can be retrieval and used to replace the defective slice. Thus, a prosthesis piece is automatically modeled with information extracted from distinct skulls with similar anatomical characteristics.

  9. Novel Simulation Framework of Three-Dimensional Skull Bio-Metric Measurement

    Directory of Open Access Journals (Sweden)

    Shihab A. Hameed

    2009-11-01

    Full Text Available Previously, most of the researcher was suffering from simulate any three dimension applications for biometrics application, likewise, various applications of forensics and cosmetology has not been easy to be simulated. Three dimensional figures have approved the fact that, it has been more reliable than two dimensional figures in most of the applications used to be implemented for the purposes above. The reason behind this reliability was the features that extract from the three dimensional applications more close to the reality. The goal of this paper is to study and evaluate how far three-dimensional skull biometric is reliable in term of the accurate measurements, capability and applicability. As it mentions above, it was hard to evaluate or simulate an application use three-dimensional skull in biometric, however, Canfield Imaging Systems provide a new suitable environment to simulate a new three-dimensional skull biometric. The second goal of this paper is to assess how good the new threedimensional image system is. This paper will also go through the recognition and verification based on a different biometric application. Subsequently this paper will study the reliability and dependability of using skull biometric. The simulation based on the three-dimensional Skull recognition using threedimensional matching technique. The feature of the simulate system shows the capability of using three-dimensional matching system as an efficient way to identify the person through his or her skull by match it with database, this technique grantee fast processing with optimizing the false positive and negative as well .

  10. IN VIVO KINEMATICS OF THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE DURING WIDE-BASED SQUAT USING A 2D/3D REGISTRATION TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Takeshi Miyaji

    2012-12-01

    Full Text Available Anterior cruciate ligament (ACL deficiency increases the risk of early osteoarthritis (OA. Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100° flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5° flexion in both phases (p < 0.05. Tibiofemoral medial contact points of the ACLD knees were more posterior than that of the contralateral knees at 5, 10 and 15° of knee flexion in the extension phase of the squat activity (p < 0.05. Tibiofemoral lateral contact points of the ACLD knees were more posterior than that of the contralateral knees at 0° flexion in the both phases (p < 0.05. The kinematics of the ACLD and contralateral intact knees were similar during the wide-based squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension

  11. A STUDY ON TUBERCLE S AT THE ANTERIOR MARGIN OF THE FORAMEN MAGNUM

    Directory of Open Access Journals (Sweden)

    Md. Khaleel

    2014-12-01

    Full Text Available The basilar process of occipital bone is formed by fusion of the first three primitive vertebrae (or occipitoblasts, the most caudal of which is so - called occipital vertebra or pro - atlas. The failure of distal occipitoblasts to fuse with others gives rise to abnormal bone formations on the external surface of skull around foramen magnum, phenomenon called as “ manifestation of occipital vertebra”. Bone anomalies related to failure of segmentation of the most caudal occipital sclerotomes are rare, but have been identified. The anomaly leads to abnormal bone formation in the region of anterior rim of foramen magnum, either in the midline and or laterally. The anomaly has been occasionally referred to as third condyle, remanants of occipital vertebra, un - formed bon e masses on the anterior rim of foramen magnum and prebasi - occipital arch in combination with an odontoid bone. The basiocciput of 100 Indian adult human skulls were examined for the presence of precondylar tubercles, which are single or paired osseous formations anterior to the occipital condyles and foramen magnum. Out of these 100 skulls , one skull displayed unilateral tubercle and the other bilateral tubercles.

  12. Glottic and skull indices in canine brachycephalic airway obstructive syndrome

    OpenAIRE

    R. Caccamo; P. Buracco; De La Rosa, G; M. Cantatore; S.Romussi

    2014-01-01

    Background Forty dogs presented for brachycephalic airway obstructive syndrome with laryngeal collapse not over 1st degree (saccule eversion) underwent glottis endoscopic and radiographic skull measurements before surgery. Fifteen Pugs, fifteen French and ten English Bulldogs were included. The goals were prospectively to compare three common brachycephalic breeds for anatomical differences regarding glottis and skull measurements, and to assess if any correlation between glottis and skull me...

  13. A study on evaluation of skull base bone involvement of nasopharyngeal cancer with 99Tcm-MDP SPECT combined localizable CT%99Tcm-MDP SPECT结合定位CT评价鼻咽癌颅底骨侵犯

    Institute of Scientific and Technical Information of China (English)

    姚红霞; 刘生; 蒋宁一; 张弘; 陈少雄; 刘幸光; 卢献平; 梁九根; 张金山

    2009-01-01

    目的 用99Tcm-亚甲基二膦酸盐(MDP)SPECT结合定位CT.评价鼻咽癌(NPC)颅底骨侵犯(SBBI).方法 NPC患者44例,1周内行头颅Tcm-MDP SPECT、定位CT、全身骨显像(WBI)和MRI检查,对照组10例其他部位肿瘤患者行头颅99Tcm-MDP SPECT结合定位CT显像.于SPECT图像矢状面,颅底放射性浓聚程度最高(L)层面与高位颈椎体(C1-C3,S)处勾画相同大小的感兴趣区(ROI),L/S>1提示SBBI.对计数资料行X2检验或Fisher精确概率检验.结果 (1)对照组10例L/S=0.66±0.13.(2)根据MRI结果,SPELL结合定位CT、WBI和单独SPECT诊断SBBI的灵敏度、特异性、准确性分别为83.3%(20/24)、80.0%(16/20)、81.8%(36/44),70.8%(17/24)、70.0%(14/20)、70.4%(31/44)和77.3%(17/22)、72.7%(16/22)、75.0%(33/44),差异无统计学意义(X2=2.00,P=0.37);SPECT结合定位CT与MRI相关[X2=17.65,相依系数(CC)=0.535,P<0.05].(3)头痛组与无头痛组SBBI阳性率分别为92.9%(13/14)与36.7%(11/30),差异有统计学意义(X2=12 16,P<0.05),低分化鳞癌组与未分化癌组SBBI阳性率分别为50.O%(19/38)与83.3%(5/6),差异无统计学意义(X2=2.69,P=0.19).(4)SPECT结合定位CT图像除能提供准确的定位外,还能检测部分颅底骨破坏.结论 SPECT结合定位CT能有效地检测鼻咽癌SBBI.%Objective Whole body planar bone imaging(WBI)could not accurately evaluate skull base bone involvement(SBBI)due to complex structure of the nasopharynx.The purpose of this study was to preliminarily evaluate the role of SPECT combined localizable CT for diagnosing SBBI of nasopharyngeal cancer(NPC).Methods Forty-four patients with NPC underwent the skull 99Tcm-methylene diphosphonate (MDP)SPECT combined localizable CT,WBI and MRI within a week.Ten patients with non NPC were controls.The region of interest(ROI)of the suspected SBBI(L)was drawn and the same ROI was copied to the upper cervical vertebrae C1 to C3(S)on the 99Tcm-MDP sagittal SPECT imping.The uptake ratio of L and S(L/S)was calculated and

  14. Cave crawling in zebra finch skulls

    DEFF Research Database (Denmark)

    Larsen, Ole Næsbye; Salomon, Rasmus; Jensen, Kenneth Kragh;

    Cave crawling in zebra finch skulls: what is the functional interaural canal? Ole Næsbye Larsen, Rasmus Salomon, Kenneth Kragh Jensen, and Jakob Christensen-Dalsgaard Department of Biology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark The middle ears of birds are...... gains and delays in the IAC can produce very different directionalities of the ears but it is still uncertain how interaural transmission gain and delay can be shaped by evolution by anatomical adaptations. A closer inspection of the zebra finch cranium using micro-CT scanning reveals that not only is...

  15. Bilateral anterior shoulder dislocation

    OpenAIRE

    Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

    2013-01-01

    Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side...

  16. Cases of Trephination in Ancient Greek Skulls

    Directory of Open Access Journals (Sweden)

    Vasiliki Ζafiri

    2012-01-01

    Full Text Available Background: Trephination, or trepanning, is considered to be one of the most ancient surgical operations with an especially extensive geographical incidence, both in the New World and in the Old. In Europe, more than 200 finds of trephination have been found, from Scandinavia to the Balkans. The technique of trephination or trepanning covers overall the last 10,000 years and exhibits great versatility and adjustability in the knowledge, technical means, therapeutic needs, prejudices and social standards of each period and of each population group. Hippocrates was the one to classify for the first time the kinds of cranial fractures and define the conditions and circumstances for carrying out a trepanning.Aim: The present research aims to investigate the Greek cranial trephinations on sculls from the collection of the Anthropological Museum of the Medical School of Athens that come from archaeological excavations.Method: Skulls were examined by macroscopic observation with reflective light. Furthermore, radiographic representation of the skulls was used.Results: The anthropological researches and the studies of anthropological skeleton remains that came out during archaeological excavations from different eras and areas have given information about the medical practices in the very important geographic area of Greece and in particular, we referred to cases of Greek trephinations.

  17. Effect of Connector Design on Fracture Resistance in Zirconia-based Fixed Partial Dentures for Upper Anterior Region.

    Science.gov (United States)

    Ogino, Yasushi; Nomoto, Syuntaro; Sato, Toru

    2016-01-01

    The purpose of this study was to investigate the influence of the cross-sectional form and area of the connector on fracture resistance in three-unit zirconia fixed partial denture (FPD) frameworks for the upper anterior region. Sixty FPD framework specimens were fabricated using the CAD/CAM system. The cross-sectional form (Type I, II, or III) and area (9.0, 7.0, 5.0, or 3.0 mm(2)) of the connectors differed. The specimens were fixed to a jig capable of applying a load axially to the abutment teeth at an angle of 135 degrees. Each specimen was subjected to fracture load measurements using a universal testing machine and cross-sectional microscopic examination. Fracture load fell significantly with a decrease in cross-sectional area (p 5.0 mm(2). PMID:27320295

  18. Sagittal synostosis: I. Preoperative morphology of the skull

    DEFF Research Database (Denmark)

    Guimaraes-Ferreira, J.; Gewalli, F.; David, L.; Darvann, Tron Andre; Hermann, N.V.; Kreiborg, S.; Friede, H.; Lauritzen, C.G.K.

    2006-01-01

    The aim of this study was to characterise the preoperative morphology of the skull in sagittal synostosis in an objective and quantified way. The shapes of the skulls of 105 patients with isolated premature synostosis of the sagittal suture ( SS group) were studied and compared with those of a co...

  19. Intrauterine skull depression and intracranial hemorrhage in a premature infant

    International Nuclear Information System (INIS)

    The authors describe a case of a premature infant born with a parietal skull depression who suffered an intraventricular hemorrhage and an ipsilateral intracerebral injury. At 21 months of life the infant's gross motor milestones were delayed and he had moderate spastic hemiplegia. Although skull depressions at birth are usually benign, they may be associated with long-term neurologic sequelae. (orig.)

  20. Skull-stripping for Tumor-bearing Brain Images

    CERN Document Server

    Bauer, Stefan; Reyes, Mauricio

    2012-01-01

    Skull-stripping separates the skull region of the head from the soft brain tissues. In many cases of brain image analysis, this is an essential preprocessing step in order to improve the final result. This is true for both registration and segmentation tasks. In fact, skull-stripping of magnetic resonance images (MRI) is a well-studied problem with numerous publications in recent years. Many different algorithms have been proposed, a summary and comparison of which can be found in [Fennema-Notestine, 2006]. Despite the abundance of approaches, we discovered that the algorithms which had been suggested so far, perform poorly when dealing with tumor-bearing brain images. This is mostly due to additional difficulties in separating the brain from the skull in this case, especially when the lesion is located very close to the skull border. Additionally, images acquired according to standard clinical protocols, often exhibit anisotropic resolution and only partial coverage, which further complicates the task. There...

  1. Comparative analysis of the anterior and posterior length and deflection angle of the cranial base, in individuals with facial Pattern I, II and III

    Directory of Open Access Journals (Sweden)

    Guilherme Thiesen

    2013-02-01

    Full Text Available OBJECTIVE: This study evaluated the variations in the anterior cranial base (S-N, posterior cranial base (S-Ba and deflection of the cranial base (SNBa among three different facial patterns (Pattern I, II and III. METHOD: A sample of 60 lateral cephalometric radiographs of Brazilian Caucasian patients, both genders, between 8 and 17 years of age was selected. The sample was divided into 3 groups (Pattern I, II and III of 20 individuals each. The inclusion criteria for each group were the ANB angle, Wits appraisal and the facial profile angle (G'.Sn.Pg'. To compare the mean values obtained from (SNBa, S-N, S-Ba each group measures, the ANOVA test and Scheffé's Post-Hoc test were applied. RESULTS AND CONCLUSIONS: There was no statistically significant difference for the deflection angle of the cranial base among the different facial patterns (Patterns I, II and III. There was no significant difference for the measures of the anterior and posterior cranial base between the facial Patterns I and II. The mean values for S-Ba were lower in facial Pattern III with statistically significant difference. The mean values of S-N in the facial Pattern III were also reduced, but without showing statistically significant difference. This trend of lower values in the cranial base measurements would explain the maxillary deficiency and/or mandibular prognathism features that characterize the facial Pattern III.OBJETIVO: o presente estudo avaliou as variações da base craniana anterior (S-N, base craniana posterior (S-Ba, e ângulo de deflexão da base do crânio (SNBa entre três diferentes padrões faciais (Padrão I, II e III. MÉTODOS: selecionou-se uma amostra de 60 telerradiografias em norma lateral de pacientes brasileiros leucodermas, de ambos os sexos, com idades entre 8 anos e 17 anos. A amostra foi dividida em três grupos (Padrão I, II e III, sendo cada grupo constituído de 20 indivíduos. Os critérios de seleção dos indivíduos para cada grupo

  2. Skull fracture and hemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis

    Directory of Open Access Journals (Sweden)

    Chandrabhal Tripathi

    2010-07-01

    Full Text Available BACKGROUND: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial hemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial hemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. METHODS: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. RESULTS: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. CONCLUSIONS: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.

  3. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... Help a Friend Who Cuts? Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  4. The Curious History of the Talgai Skull

    Directory of Open Access Journals (Sweden)

    Jim Allen

    2010-11-01

    Full Text Available In the Australian winter of 1886 William Naish, a shearer in summer and a fencing contractor in the winter, erected a farm fence along Dalrymple Creek on East Talgai Station, c.125 km southwest of Brisbane. Work was interrupted by six days of torrential rain. On returning to the site Naish found that the rain had extended an erosion channel which he now had to cross walking to work, and from the extended section he retrieved a skull, heavily encrusted in carbonate, but clearly of human origin. Although it would take three decades to recognise and a further five to confirm, Naish had discovered the first direct proof of the Pleistocene antiquity of humans in Australia. Details of this history of Talgai are taken principally and extensively from Macintosh (1963, 1965, 1967a, 1967b, 1969, Elkin (1978, Gill (1978 and Langham (1978.

  5. Digital modelling of a human skull

    Directory of Open Access Journals (Sweden)

    O. Etxaniz

    2008-03-01

    Full Text Available Purpose: This paper describes the first step of a project that aims to improve the design and placement of dental prostheses through an in-depth analysis of jaw movement. This analysis requires prior obtaining quality digital models of all elements involved in the movement. The paper describes the process to obtain the digital models through Reverse Engineering techniques, and evaluates their quality.Design/methodology/approach: The process of digitalization of a human skull by means of a hand-held 3D laser scanner has been evaluated to see the suitability of this technique. A skull has been chosen as test element as it has several characteristics that make its digitisation by optical techniques difficult, such as a non-uniform surface and a complex geometry. The surfaces obtained by the scanner have been edited by point cloud edition software.Findings: Reverse Engineering optical hardware has several limitations to correctly digitize complex geometries, but these deficiencies can be solved using the Reverse Engineering software properly.Research limitations/implications: The same analysis should be performed by point clouds obtained through other Reverse Engineering technologies, such as structured light scanners. These technologies can achieve best values of accuracy and resolution, so that both results should be compared.Practical implications: This paper gives the chance to apply Reverse Engineering techniques to achieve high quality digital models of free form complex geometries. The constraints presented by optical digitization technologies can be solved through powerful point cloud edition software.Originality/value: This paper describes the process of digitalization of complex free form geometries and the subsequent point cloud edition.

  6. Repair of large frontal temporal parietal skull defect with digitally reconstructed titanium mesh: a report of 20 cases

    Directory of Open Access Journals (Sweden)

    Gang-ge CHENG

    2013-09-01

    Full Text Available Objective To explore the clinical effect and surgical technique of the repair of large defect involving frontal, temporal, and parietal regions using digitally reconstructed titanium mesh. Methods Twenty patients with large frontal, temporal, and parietal skull defect hospitalized in Air Force General Hospital from November 2006 to May 2012 were involved in this study. In these 20 patients, there were 13 males and 7 females, aged 18-58 years (mean 39 years, and the defect size measured from 7.0cm×9.0cm to 11.5cm×14.0cm (mean 8.5cm×12.0cm. Spiral CT head scan and digital three-dimensional reconstruction of skull were performed in all the patients. The shape and geometric size of skull defect was traced based on the symmetry principle, and then the data were transferred into digital precision lathe to reconstruct a titanium mesh slightly larger (1.0-1.5cm than the skull defect, and the finally the prosthesis was perfected after pruning the border. Cranioplasty was performed 6-12 months after craniotomy using the digitally reconstructed titanium mesh. Results The digitally reconstructed titanium mesh was used in 20 patients with large frontal, temporal, parietal skull defect. The surgical technique was relatively simple, and the surgical duration was shorter than before. The titanium mesh fit to the defect of skull accurately with satisfactory molding effect, good appearance and symmetrical in shape. No related complication was found in all the patients. Conclusion Repair of large frontal, temporal, parietal skull defect with digitally reconstructed titanium mesh is more advantageous than traditional manual reconstruction, and it can improve the life quality of patients.

  7. SKIN SEGMENTATION AND SKULL SEGMENTATION FOR MEDICAL IMAGING

    Directory of Open Access Journals (Sweden)

    Eric Yogi Tjandra

    2014-01-01

    Full Text Available In this paper aims we present tools for medical imaging applications to do skin and skull segmentation in a short time. The desired output for skin segmentation is a 3D visualization of the facial skin without any cavities or holes inside the head, while skull segmentation aims to create a 3D visualization of the skull bones. The algorithm used for skin segmentation is thresholding the image, extracting the largest connected component, and holefilling to fill the unnecessary holes. As for the skull segmentation, the process is done by removing the spines which is connected to the skull, and then extracting the largest connected component. Afterwards, mesh generation is done to produce the 3D objects from the processed images. This mesh generation process is done using the marching cubes algorithm. The testing results show that the skin and skull segmentation process will work well when there are no other objects that are connected to the skin or the skull. Skin segmentation process takes a significant amount of time, primarily caused by the holefilling process.

  8. 综合护理干预对颅底肿瘤切除术后患者吞咽障碍的作用%Comprehensive nursing intervention on effect of swallowing disorder in patients with after tumor resection of skull base

    Institute of Scientific and Technical Information of China (English)

    汪卫萍

    2015-01-01

    Objective:To study the comprehensive nursing intervention for patients with swallowing disorder after the tumor resection of the skull base.Methods:from March 2012 -March 2013 in our hospital 120 cases of swallowing disorder after the tumor resection of the skull base, had been randomly divided into observation group and control group.Observation group adopts comprehensive nursing inter-vention, the control group using conventional care method, compared two groups of patients discharged from hospital when swallowing function recovery.Results:the observation group total effective rate (100%) patients with swallowing functional recovery significantly higher than that of control group (75%) (P <0.05).Conclusion: comprehensive nursing intervention could effectively improve the swallowing disorder after the tumor resection of the skull base, might be worth promoting.%目的:探讨综合护理干预对颅底肿瘤切除术后患者吞咽障碍的作用。方法:选取了2012年3月~2013年3月于我院收治的120例颅底肿瘤切除术后吞咽障碍患者,将其随机分成观察组与对照组。观察组采用综合护理干预,对照组采用常规护理方法,对比分析2组患者出院时吞咽功能的恢复状况。结果:观察组患者吞咽功能恢复的总有效率(100%)要明显高于对照组(75%)(P<0.05)。结论:综合护理干预能够有效改善颅底肿瘤切除术后吞咽障碍,值得推广。

  9. Biomechanical analysis of biphasic distribution of skull injury in falls from height.

    Science.gov (United States)

    Park, Sungji; Cha, Jang Gyu; Lee, Youngseok; Seo, Insoo; Lee, Bongwoo; Choi, Youngshik; Choi, Woongchul; Yang, Kyungmoo

    2015-10-01

    Fall from height is one of the most common ways of suicide in Korea. Skull fractures are typically accompanied with these cases, but several autopsy cases show absence of skull fracture even with serious body injuries including sternal and vertebral fracture. The mechanism of this pattern of injury can be explained by impact of facial part on chest or abdomen when the back of the body touches the ground first. We tried to figure out the relevance of this pattern of injury to the height of fall using a computer simulation tool (MADYMO 7.5). For this experiment, a condition of initial pose was limited to leaning forward. The simulation showed that when the body rotated forward, the body parts which got injured by the ground depended on the height of fall. For relatively lower height, head got injured, but as the height was set higher, the point of first impact area changed to the back, hip and then legs. When the body struck first around hip area on supine position, the impact made forceful flexion of lumbar, thoracic and cervical vertebrae, leading to folding the body in two, which resulted in collision between the part of face and the anterior part of body. Through the current investigation, it was explained that the biphasic distribution of the number of head injury cases versus the height distribution was attributed to the forward rotation of the body during the fall. PMID:26159255

  10. Correlation of petrous bone convergence angle and slope of its walls with dimensional skull characteristics of human craniotypes

    Directory of Open Access Journals (Sweden)

    Rossoshanskiy D.N.

    2012-12-01

    Full Text Available

    The aim. The purpose of this paper is to study the correlation between the angles of convergence and slope of the pyramids of the temporal bone and linear and angular parameters of the cranial depending on the basilar angle. Materials and Methods. Material study is based on 100 skulls of adult humans, divided into three craniotypes. The method of measurement were made craniotopometric these parameters with further calculation of average values of the calculated and the drafting of the correlation model. The results. Study of features of the correlation angle of convergence and the slope of the pyramids of the temporal bone and linear and angular parameters of the cranial showed varying in strength and direction of the relationship of each craniotypes. Conclusion. During the study, flexibasilar craniotypes installed close inverse relationship between: tilt the front surface of the pyramids and the long base of the skull; convergence angle of the pyramids and the length of posterior skull base, the long base of the skull to the posterior edge of the large aperture. In mediobasilar craniotypes study parameters showed mostly moderate and weak degree of multidirectional nature. For platibasilar craniotypes characterized by a close direct correlation between the convergence angle of the pyramids and the length of posterior skull base. Other dimensions of the pyramid of the temporal bone are subject to greater variability can be explained by complex, multi-directional factors shaping the internal structures of the skull base.

  11. Perioperative Complications Prognosis Based on Local Neurocirculatory and Trophic Changes in the Anterior Eye Segment in Pseudoexfoliation Syndrome (Report II

    Directory of Open Access Journals (Sweden)

    A.V. Petrayevsky

    2009-03-01

    Full Text Available ABSTRACT Purpose To develop clinical method of prognosis of cataract surgery possible complications in pseudoexfoliation syndrome (PES patients convenient for routine practice of the ophthalmosurgeon. Material and methods We examined 111 patients (111 eyes between the ages of 58 and 76, who were operated for cataract. Of those, 66 patients (66 eyes had cataract combined with PES and 45 patients (45 eyes had cataract without PES signs. We used the following examination methods: visometry, eye anterior segment biomicroscopy with estimation of severity of iris trophic changes and pseudoexfoliation signs according to special classification schemes, computer tonography, ultrasonic biometry, ophthalmometry, vasotonometry in anterior ciliary arteries (ACA, and pupil cycle time (PCT calculation. The patients with cataract were operated by extracapsular extraction using corneal access in 60% of cases, and by mechanical phacofragmentation using scleral access in 40% of cases. All patients were implanted posterior chamber intraocular lenses (IOL. In the patients with cataract and PES we additionally used intracapsular extraction with implantation IOL RSP3 in 15% of cases. Results In operated patients, we recorded such complications of cataract sur gery as lens posterior capsule rupture, zonula fibers rupture, fibrinoidtype reactions, and postoperative ocular hypertension. The rate of complications was higher in PES patients (37,9% and lower in patients without PES (17,8%. An average PCT was 1840±82 ms in PES against 1186±35 ms without PES. ACA blood pressure in the PES-patients was 44,1±1,0 mm Hg against 53,1±0,98 mm Hg in the patients without PES. The rate of iris trophic changes was significantly higher in PES-patients than in the patients without PES. The rate of complications depended on frequency and severity of iris trophic changes and intensity of PES. Most of complicated cases were observed in the PES-patients with III–IV grade of PES

  12. Anterior cervical plating

    Directory of Open Access Journals (Sweden)

    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  13. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... or playing soccer). You have flat feet. Anterior knee pain is more ... skiers, bicyclists, and soccer players who exercise often ...

  14. Anterior knee pain

    Science.gov (United States)

    ... or playing soccer). You have flat feet. Anterior knee pain is more common in: People who are overweight People who have had a dislocation, fracture, or other injury to the kneecap Runners, jumpers, ...

  15. AN ATYPICAL PRESENTATION OF GROWING SKULL FRACTURE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ashok

    2015-04-01

    Full Text Available A growing skull fracture (GSF or craniocerebral erosion or leptomeningeal cyst, is characterized by progressive diastatic enlargement of fracture line. Growing skull fracture is a rare neurological complication and ac counts for 1.2 - 1.6% of the head injury patients. GSF is generally seen in children less than 3 year of age. Authors present an atypical case of growing skull fracture in comminuted type of skull fracture which was timely and successfully managed with very good outcome. Atypical presentation, risk factors, etiopathogenesis, management and outcome in GSF is discussed along with review of literature. Delayed diagnosis and improper treatment could worsen this condition while timely surgical intervention can hav e excellent outcome.

  16. Surgical treatment and results in growing skull fracture

    Directory of Open Access Journals (Sweden)

    Batuk Diyora

    2011-01-01

    Full Text Available Growing skull fracture is a rare complication of skull fracture and remains almost undetected in the first few years of life. Here, we report a series of 11 patients with growing skull fracture treated at our institute over a period of five years and discuss their clinical features, radiological findings, and principles of management. Of the 11 patients, six were females and five males, with the age ranging between 9 months and 12 years (mean, 3 years. Progressive scalp swelling was the most common presenting feature. Other clinical features included generalised tonic clonic seizures, eyelid swelling, and proptosis. Computed tomography scan of the head defined the growing skull fracture in all 11 patients and detected the underlying parenchymal injury. Postoperatively, all patients had a complete resolution of the scalp swelling. Two patients had postoperative seizures and one had cerebrospinal fluid leak. Early recognition and surgical repair is essential to prevent the development of neurological complications and cranial asymmetry.

  17. Larval development and evolutionary origin of the anuran skull

    Czech Academy of Sciences Publication Activity Database

    Roček, Zbyněk

    Vol. 7. Chipping Norton : Surrey Beatty & Sons, 2003 - (Heatwole, H.; Davies, M.), s. 1877-1995 ISBN 0-949324-94-9 Institutional research plan: CEZ:AV0Z3013912 Keywords : Amphibia * Anura * skull Subject RIV: EA - Cell Biology

  18. Costs and benefits of skull radiography for head injury

    International Nuclear Information System (INIS)

    Over a period of 10 weeks, nine accident-and-emergency units in England, Wales, and Scotland took part in an investigation into the use of skull radiography in the management of patients with head injury. The yield of potentially important radiological findings in 4829 patients with uncomplicated head injury was 2 basal, 1 frontal, and 64 vault fractures. In 4 of these patients intracranial haematomas developed, of which 3 would have been suspected clinically and the patients admitted for observation even if skull radiography had not been available. At best, skull radiography could have contributed to the detection of only 1 of the 4 intracranial haematomas. The incidence of unsuspected intracranial haematoma with skull fracture among patients with uncomplicated head injury currently radiographed in the United Kingdom is therefore 1 in 4800. The radiological cost of identifying this 1 patient in our series was Pound43,200. (author)

  19. Morphological Study of Wormian Bones in Dried Human Skulls

    OpenAIRE

    Divyesh Patel; Ketan Chauhan; Dhananjay Patil

    2015-01-01

    Background: Wormian bones may be defined as a those accidental bones found in the cranium having no regular relation to their normal ossification centre. They are assocated with cranial and central nervous system abnormalities. Knowledge of these bones is important for anthropo-logists, forensic experts, radiologists, orthopedic and neurosurgeons to avoid misleading for multiple fractures of the skull. Materials and Methods: Adult dry human skulls (n= 27) of unknown age and sex availablei...

  20. Growing skull fractures: occipital intradiploic extension of the leptomeningeal cyst

    International Nuclear Information System (INIS)

    Growing skull fractures are very rare complications of childhood head injuries. Their early detection is essential in the attempt to prevent secondary cerebral atrophy. the most common site is the parietal or frontoparietal region. We present a case of growing skull fracture extending into the occipital diploid, space, an uncommon finding and unusual presentation of lesions of this type. In our patient, computed tomography provided the key to the diagnosis. (Author) 10 refs

  1. The 'lamellated' skull in. beta. -thalassaemia

    Energy Technology Data Exchange (ETDEWEB)

    Orzincolo, C. (St. Anna Hospital, Ferrara (Italy). Dept. of Radiology); Castaldi, G. (St. Maria delle Croci Hospital, Ravenna (Italy). Dept. of Medicine); Scutellari, P.N. (Ferrara Univ. (Italy). Inst. of Radiology); Franceschini, F. (Ferrara Univ. (Italy). Inst. of Medical Semeiotica)

    1989-08-01

    The skull in homozygous {beta}-thalassaemia may present several abnormalities, such as osteopenia, widening of the diploic space, and a 'hair-on-end' appearance. In some cases it presents also a particular stratified appearance caused by a variable number of osseous lamellae, parallel with the inner table. This 'lamellated skull' was observed in 16 out of 150 patients affected by the disease (10.6%). (orig./GDG).

  2. Historical evidence of the 1936 Mojokerto skull discovery, East Java.

    Science.gov (United States)

    Huffman, O Frank; Shipman, Pat; Hertler, Christine; de Vos, John; Aziz, Fachroel

    2005-04-01

    To resolve ambiguities in the literature, we detail the discovery history of the Mojokerto child's skull (Perning 1), employing letters, maps, photographs, reports, and newspaper accounts not previously used for this purpose. Andoyo, an experienced vertebrate-fossil collector with the Geological Survey of the Netherlands Indies, found the skull on February 13, 1936, while collecting for Johan Duyfjes, who had mapped the field area geologically. On February 18-19 Andoyo sent the fossil and a 1:25,000-topographic map showing the discovery point to Survey headquarters. The locality lies between Perning and Sumbertengu villages, approximately 10km northeast of Mojokerto city, East Java. G.H. Ralph von Koenigswald, Survey paleontologist, identified the specimen as Pithecanthropus and then named it Homo modjokertensis (it is now accepted as Homo erectus). Unfortunately he confused the discovery record in a March 28 newspaper article by characterizing the skull as a "surface find" [Dutch: oppervlaktevondst] while also attributing it to ancient beds. von Koenigswald probably had insufficient basis for either assertion, having not yet talked to Andoyo or Duyfjes. Eugene Dubois challenged von Koenigswald on the "surface-find" issue, Andoyo was consulted, and Duyfjes went to the site. Duyfjes and von Koenigswald then published scientific papers stating that the skull was unearthed 1m deep from a hill-slope outcrop of conglomeratic sandstone in Duyfjes' Pucangan formation. A cross section by Andoyo, which may show the Mojokerto site, also indicates a skull at 1m depth in conglomeratic sandstone. Photographs taken in 1936-1938 show a shallow pit at a single field location that fits Duyfjes' site description and is identified as the Mojokerto-skull site in 1940-1943 publications. By WWII the scientific community accepted the skull as an early hominid. Although von Koenigswald's "surface-find" comment remains a source of doubt in the record, we consider in situ discovery for the

  3. The furnace for crystal growth by directional solidification in skull crucible

    OpenAIRE

    Таранюк, Владимир Иванович; Гектин, Александр Вульфович; Колесников, Александр Владимирович

    2014-01-01

    The furnace, based on the skull method for obtaining laboratory samples of halide crystals (40 mmin diameter and15 mmhigh) with the melting temperature of900 °C, is considered in the paper. This technological solution allows growing crystals without using expensive platinum crucibles and moving or rotating design elements. The process control system and the thermal unit design are designed for determining and controlling temperature and a thermal gradient for carrying out crystal growth and m...

  4. Analysis of Induction Skull Melting Furnace by Edge Finite Element Method excited from Voltage Source

    OpenAIRE

    Cingoski, Vlatko; Yamashita, Hideo

    1994-01-01

    To optimize the production of high-efficiency induction skull melting furnace, we analyzed magnetic flux density, eddy current and electromagnetic flux density, eddy current and electromagnetic force distributions using 3-D edge- based finite element method excited from a voltage source. Changing the number of copper rods and, therefore the distance between them, we analyzed both the intensity and direction of the electromagnetic forces and the amount of power consumed by the molten alloy and...

  5. Stature and gender determination and their correlation using odontometry and skull anthropometry

    OpenAIRE

    Amit Gupta; Kiran Kumar; Devi Charan Shetty; Vijay Wadhwan; Anshi Jain; Kaveri Surya Khanna

    2014-01-01

    Background: When the body has been mutilated, it is common to have the extremities or head amputated from the trunk. In concern with forensic odontology, an estimate must have been made based on the correlation of osteometry along with odontometry in determining sex, race and stature. Objective: The objective of this study is to investigate and correlate height and gender from odontometry and anthropometric data of the skull. Materials and Methods: The study was conducted in the Department of...

  6. Simulation of bone-conducted sound transmission in a three-dimensional finite-element model of a human skull

    Science.gov (United States)

    Chang, You; Kim, Namkeun; Stenfelt, Stefan

    2015-12-01

    Bone conduction (BC) is the transmission of sound to the inner ear through the bones of the skull. This type of transmission is used in humans fitted with BC hearing aids as well as to classify between conductive and sensorineural hearing losses. The objective of the present study is to develop a finite-element (FE) model of the human skull based on cryosectional images of a female cadaver head in order to gain better understanding of the sound transmission. Further, the BC behavior was validated in terms of sound transmission against experimental data published in the literature. Results showed the responses of the simulated skull FE model were consistent with the experimentally reported data.

  7. Alterations of the skull Usher's syndrome

    International Nuclear Information System (INIS)

    Usher's syndrome is relatively often met. It is cited that it comprehends 2/3 of the recessive hereditary diseases in otology. Sensorineural hearing loss, vestibular dysfunction and hemeralopia are not so rarely met in our country, but their connection to this syndrome are scarcely cited in the newer specialized literature. In it we didn't find description of the characteristic, as we consider them, osteolytic focuses in the flat bones. The cases presented by us were monitored clinically and roentrgenographically for long years. Periodically were performed roentgenograms, CT and MRI of the skull, where the changes are most often met. We analyzed the imaging information that was found in our patients and compared it with the citations in world literature, which are not too many. It is analysed the course of the clinical signs and the algorithm of the imaging techniques to be evaluated the progress of the disease and the results of the applied therapy. We consider that the diagnostic and differential-diagnostic analysis of the cases will be helpful for the popularisation and the more precise diagnose of this serious disease

  8. Congenital anterior urethral diverticulum.

    Science.gov (United States)

    Singh, Sanjeet Kumar; Ansari, Ms

    2014-09-01

    Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. PMID:26328174

  9. Anterior vaginal wall repair

    Science.gov (United States)

    ... symptoms will go away. This improvement will often last for years. Alternative Names A/P repair; Vaginal wall repair; Anterior and/ ... writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Contact ... Institutes of Health Page last updated: 23 August 2016

  10. [Toxic anterior segment syndrome].

    Science.gov (United States)

    Cornut, P-L; Chiquet, C

    2011-01-01

    Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells. PMID:21176994

  11. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies

    OpenAIRE

    Gu, Wen-long; Wu, Sheng-wen

    2015-01-01

    Background Recent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; however, the necessity of it is still controversially discussed. Methods We performed this meta-analysis to provide a comprehensive evaluation of the role of defunctioning stoma in low anterior resection for rectal cancer on the rates of anastomotic leakage and reoperation related to leakage with or without defunctioning stoma by calculating the pooled risk ratio. Res...

  12. CT-based study of internal structure of the anterior pillar in extinct hominins and its implications for the phylogeny of robust Australopithecus

    OpenAIRE

    Villmoare, Brian A.; Kimbel, William H.

    2011-01-01

    The phylogeny of the early African hominins has long been confounded by contrasting interpretations of midfacial structure. In particular, the anterior pillar, an externally prominent bony column running vertically alongside the nasal aperture, has been identified as a homology of South African species Australopithecus africanus and Australopithecus robustus. If the anterior pillar is a true synapomorphy of these two species, the evidence for a southern African clade of Australopithecus would...

  13. Lengths of the maxillary central incisor, the nasal bone, and the anterior cranial base in different skeletal malocclusions

    DEFF Research Database (Denmark)

    Arntsen, Torill; Kjær, Inger; Sonnesen, Liselotte

    malocclusions. Material and methods . Incisor, nasal, and cranial base lengths were measured on lateral radiographs of adult patients with skeletal malocclusions, including open bite (n=35), mandibular overjet (n=56), maxillary overjet (n=31), deep bite (n=19), and compared with those of a control group with...... skeletal malocclusions. The present findings, especially the deviation of the upper incisor length in different skeletal malocclusions, are considered relevant for orthodontic diagnostics and treatment....

  14. Influence of head mass on temporo-parietal skull impact using finite element modeling.

    Science.gov (United States)

    Sahoo, Debasis; Deck, Caroline; Yoganandan, Narayan; Willinger, Rémy

    2015-09-01

    The effect of head mass on its biomechanical response during lateral impact to the head is investigated in this computational study. The mass of the head of a state-of-the-art validated finite element head model is altered by ± 10 % from the base value of 4.7 kg. Numerical simulations of lateral head impacts for 30 cases (representing 15 human cadaver experiments × 2 mass configurations) are performed using the LS-DYNA solver at different velocities ranging from 2.4 to 6.5 m/s and three impacting conditions representing different stiffness and shapes of the contact/impact surfaces. Results are compared with the original model using the baseline head mass, thus resulting in a total of 45 simulations. Present findings show that the head mass has greater influence for peak interaction forces and the force has a greater dependency on stiffness of contact surface than the shape. Mass variations have also influence on skull strain energy. Regardless of increase/decrease in skull strain energy influenced by head mass variations used in the computational study, the 50 % fracture tolerance limit was unaltered, which was 544 mJ. The present study gives a better understanding of the mechanism of temporo-parietal skull impact. PMID:25863692

  15. Chronology of the stratum containing the skull of the Dali Man

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The field investigations of geomorphology and Quaternary sediment sequences show that the sediment stratigraphic profile containing the skull of the Homo sapiens Daliensis (Dali Man) at Tianshuigou trench, Jiefang Village (109°44′E, 34°52′N ), Dali County, Shaanxi Province, is composed of the loess-paleosol sequence, 17.3 m thick, in the upper part, and the alluvial silts, fine sands and sandy gravels interbedded, 15.4 m thick, in the lower part. There are the well developed layers L1, S1, L2 and S2 in the loess-paleosol sequence of the profile, which are comparable to those of the Luochuan loess section on the basis of magnetic succeptibility measurements and IRSL dating of the loess samples. An alluvial gravel layer, where the skull of the Dali Man was discovered, is in 13 m beneath the bottom of paleosol S2, implying that, the age of the Dali Man must be older than about 247 kaBP when the paleosol S2 began to be developed. The samples of mammal animal tooth and shell fossils from the gravel layer containing the skull of the Dali Man have been dated by uranium series and ESR methods respectively. Based on the multiple dating results and the stratigraphic chronology, the age of the Dali Man, therefore, would be estimated as older than 250 kaBP and younger than 350 kaBP, and reasonably estimated as 260-300 kaBP.

  16. Geographical variation of the skull of the lesser mouse deer.

    Science.gov (United States)

    Endo, Hideki; Fukuta, Katsuhiro; Kimura, Junpei; Sasaki, Motoki; Stafford, Brian J

    2004-10-01

    We examined the geographical variation of the skull size and shape of the lesser mouse deer (Tragulus javanicus) from Laos, Thailand, Peninsular Malaysia, Sumatra, Java, Borneo, Langkawi and some Islands of Tenasserim in Myanmar. Although the influence of the climatic condition on skull size was not confirmed in the mainland populations, the skull became rostro-caudally longer in the populations of Tenasserim and Sumatra because of island isolation effect. The skull size was classified into the following three clusters of localities from the matrix of Q-mode correlation coefficients: 1) Langkawi and Tenasserim, 2) Laos and Thailand, 3) Sumatra and Borneo. The skulls in the population of Java belong to the cluster of Langkawi and Tenasserim in male, however were morphologically similar to those in the cluster of Borneo and Sumatra. The canonical discriminant analysis pointed out that the Laos and Tenasserim populations were separated from the other ones and that the populations of Sumatra, Java and Borneo were intermingled each other. PMID:15528854

  17. MORPHOMETRIC EVALUATION OF FORAMEN MAGNUM IN DRY HUMAN SKULLS

    Directory of Open Access Journals (Sweden)

    Anil Kumar

    2015-06-01

    Full Text Available The foramen magnum is an important landmark in the posterior part of the cranial base, which is largely formed by the occipital bone. The dimensions of the foramen magnum are clinically important because of the vital structures passing through it. We studied thirty six dry human skulls of known sex and measured antero-posterior and transverse diameters with the help of Vernier caliper. Additionally surface area and Index of foramen magnum were also calculated. Oval shape is the main type of morphological variant found in this study. The transverse diameter of the foramen magnum was in a range of 25.75-34.25mm in males, whereas it was between 26-31.75mm in females. The anteroposterior diameter was in a range of 35 to 39.75mm in males while it was 29.5 to 34.75mm in females. The mean area of foramen magnum in males was 876.88±88.83mm whereas it was 776.87±68.51mm in females. In contrast to the area, the mean foramen magnum index was higher in females (89.01±6.84mm compared to males (81.75±5.99mm and this difference was also statistically significant (p<0.01. The prospective study will help surgeon for reference value for determining feasibility of transcondylar surgical approach, which are being done in an increasing trend in recent times for brain stem lesion.

  18. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... confirm the diagnosis. It may also show other knee injuries. First aid for an ACL injury may include: ...

  19. [Two cases of tuberculosis of the skull cap (author's transl)].

    Science.gov (United States)

    Memin, Y; Zurbach, J; Mafart, Y; Lesobre, B; Piéron, R; Hercend, T

    The authors report two cases of tuberculosis of the skull cap. The first in a Black African with heterozygous sickle cell disease also presenting with: tuberculosis of the cervical lymph nodes, subcutaneous frontal tumefactions bacteriologically confirmed to be of tuberculous origin, multiple lacunae of the vault from the same origin; the second case is an Asian woman having a multifocal tuberculous osteitis involving the skull, spine, pelvis and probably the same affection in the spleen. These cases are a reminder that the principal features of tuberculosis of the skull vault are very often associated with other tuberculous lesions, and to the problems of diagnosis it entails; the existence of a subcutaneous tumefaction of the vault or of any accessible site one can aspirate and/or perform biopsy constitutes a diagnostic aid. PMID:6244640

  20. The relationship between skull asymmetry and CT findings

    International Nuclear Information System (INIS)

    In order to clarify the relationship between brain damage and skull asymmetry or supine head position preference, we classified CT findings of 330 cases with cerebral palsy or risk of motor disturbance into 6 groups according to skull shape. Those were severe (I, n = 37) and mild (II, n = 114) grades in the right occipital flatness, severe (III, n = 34) and mild (IV, n = 58) grades in the left occipital flatness, long skull with temporal flatness (V, n = 33) and symmetric round skull (control, n = 54). It was considered that the asymmetry of cortical atrophy in appearance was formed physicaly by skull asymmetry but that the asymmetric dilatation in appearance of lateral ventricle was related to the asymmetry of brain damage. The severity and the asymmetry of brain damage were tend to increase the grade of skull asymmetry. The incidence of cases with the right occipital flatness was 1.6 times more frequently than the left sided. The incidence of cases whose left (lateral) ventricle was larger than the right was 4.1 times more than the cases whose right ventricle was larger than the left. The cases with occipital flatness in the contralateral side of the larger lateral ventricle were found more than the cases with occipital flatness in the ipsilateral side of the larger ventricle, that is to say, the direction of supine head position preference during early infant was suspected to be the more severely disturbed side of body. These results suggest that the supine head position preference to the right in newborn babies and infants with scoliosis or cerebral palsy might be the result of transient or permanent asymmetric (left > right) brain dysfunction. (author)

  1. Anterior Cruciate Ligament Injury

    OpenAIRE

    Vilaseca, Tomas; Chahla, Jorge; Rodriguez, Gustavo Gomez; Arroquy, Damián; Herrera, Gonzalo Perez; Orlowski, Belen; Carboni, Martín

    2015-01-01

    Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational...

  2. Occipital Emissary Foramina in South Indian Modern Human Skulls

    OpenAIRE

    Singhal, Suruchi; Ravindranath, Roopa

    2013-01-01

    An occipital emissary foramen has been traditionally described as a foramen present in the squamous part of the occipital bone at the occipital protuberance transmitting a vein that connects the confluence of sinuses with the occipital vein. The present study was done on 221 South Indian adult modern human skulls of unknown sex in the Department of Anatomy, St John’s Medical College, Bangalore, India. The foramen was observed in 21/221 (9.50%) skulls, 6/21 (28.57%) to the right of, 10/21 (47....

  3. [A skull of Mesopithecus with bite marks (author's transl)].

    Science.gov (United States)

    Zapfe, H

    1981-01-01

    A skull of Mesopithecus pentelicus (Roth and Wagner) from the Turolian (Upper Miocene) of Pikermi (Greece) shows hole-shaped bitemarks. Considering the behavior and the character of the dentition of the groups of carnivores represented in Pikermi, it is supposed that these bitemarks have been caused by a felid of the size of a leopard. In the fauna of Pikermi only Metailurus parvulus (Hensel) can be taken into consideration. By the defects on a skull of a juvenile Australopithecine, interpreted by Brain in 1970 as bitemarks of a leopard, the above explanation gets a very essential support. PMID:6792015

  4. Current approach in diagnosis and management of anterior uveitis

    OpenAIRE

    Agrawal Rupesh; Murthy Somasheila; Sangwan Virender; Biswas Jyotirmay

    2010-01-01

    Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated...

  5. Simulated activity but real trauma: a systematic review on Nintendo Wii injuries based on a case report of an acute anterior cruciate ligament rupture.

    Science.gov (United States)

    Müller, Sebastian A; Vavken, Patrick; Pagenstert, Geert

    2015-03-01

    Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for "Wii (trauma or injury or fracture)." Full-text articles were included after duplicate, blinded review. The type and treatment of injury as well as the Wii-based rehabilitation programs found were analyzed. Additionally, a new case of an acute ACL tear-sustained playing, Wii boxing, is additionally presented. After exclusion of irrelevant articles, 13 articles describing Wii-related injuries were included reporting on 3 fractures, 6 nonosseous, 2 overuse injuries, and 2 rehabilitation programs using Wii for posttraumatic rehabilitation. Among the presented Wii-related injuries, only 12.5% were treated conservatively, whereas 87.5% underwent either surgical or interventional treatment. Because of the reported case, the literature search was limited to Wii-related injuries excluding other video games. Another limitation of this article lies in the fact that mainly case reports but no controlled trials exist on the topic. Assumingly, primarily the more severe injuries are reported in the literature with an unknown number of possibly minor injuries. Motion-controlled video games, such as Wii, are becoming increasingly popular as a recreational entertainment. Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations. PMID:25816033

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

    Science.gov (United States)

    Salyer, K E; Gendler, E; Squier, C A

    1997-05-01

    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. PMID:9145145

  7. [Somatotopic Representation of the Anterior Horn within Cervical Enlargement: Reappraisal of Known Doctrine Based on Clinicopathological Findings Seen in Hirayama Disease].

    Science.gov (United States)

    Hirayama, Keizo

    2016-05-01

    Clinical features (weakness and amyotrophy of intrinsic hand muscles and obliquely distributed amyotrophy of forearm muscles, figure 1), needle electromyographic findings (distribution of neurogenic activities, figure 2), and pathological findings (ischemic necroses of the anterior horns between C6 and T1, figure 3) of Hirayama disease suggest that understanding of somatotopic representation of the anterior horn innervating arm muscles in the cervical enlargement of spinal cord differs from the known doctrine. Anterior horn cells of the intrinsic hand muscles are located between C7 and T1, those of forearm muscles and triceps brachii muscle as elbow extensor are, contrary to the known doctrine, located in C5 and C6, and those of elbow flexors such as biceps brachii and brachioradialis are located in C4 and above (figure 5). Development of dexterity in human hand may reflect development of cervical enlargement in accord with larger areas representing the hand and fingers on cerebral motor cortex. PMID:27156506

  8. STUDY ON THE OCCURRENCE OF WORMIAN BONES AMONG THE MALE AND FEMALE SKULLS OF TAMIL NADU, INDIA

    Directory of Open Access Journals (Sweden)

    A. Mary Antony Praba

    2015-12-01

    Full Text Available Background: Wormian bones, also known as intra sutural bones are extra bone pieces that occur within a suture in the cranium. These are irregular isolated bones which appear in addition to the usual centers of ossification of the cranium and, although unusual, are not rare. The number of sutural bones varies considerably because different individuals and different population have different numbers of sutural bones. They occur mostly along the sutures and meeting point of the cranial sutures. They occur most frequently in the course of the lambdoid suture. They are also occasionally seen within the sagittal and coronal sutures. Materials and Methods: In this present study we analyzed the occurrence of sutural bones among 50 male and female skulls in Tamil Nadu region and we compared the results along with the studies of Indian skulls. Result and Conclusion: Based on the study we concluded that sutural bones are more among male skulls than in females among the skulls of Tamil Nadu and this is exactly the opposite of the results given in Indian population.

  9. Evolutionary patterns of shape and functional diversification in the skull and jaw musculature of triggerfishes (Teleostei: Balistidae).

    Science.gov (United States)

    McCord, Charlene L; Westneat, Mark W

    2016-06-01

    The robust skull and highly subdivided adductor mandibulae muscles of triggerfishes provide an excellent system within which to analyze the evolutionary processes underlying phenotypic diversification. We surveyed the anatomical diversity of balistid jaws using Procrustes-based geometric morphometric analyses and a phylomorphospace approach to quantifying morphological transformation through evolution. We hypothesized that metrics of interspecific cranial shape would reveal patterns of phylogenetic diversification that are congruent with functional and ecological transformation. Morphological landmarks outlining skull and adductor mandibulae muscle shape were collected from 27 triggerfish species. Procrustes-transformed skull shape configurations revealed significant phylogenetic and size-influenced structure. Phylomorphospace plots of cranial shape diversity reveal groupings of shape between different species of triggerfish that are mostly consistent with phylogenetic relatedness. Repeated instances of convergence upon similar cranial shape by genetically disparate taxa are likely due to the functional demands of shared specialized dietary habits. This study shows that the diversification of triggerfish skulls occurs via modifications of cranial silhouette and the positioning of subdivided jaw adductor muscles. Using the morphometric data collected here as input to a biomechanical model of triggerfish jaw function, we find that subdivided jaw adductors, in conjunction with a unique cranial skeleton, have direct biomechanical consequences that are not always congruent with phylomorphospace patterns in the triggerfish lineage. The integration of geometric morphometrics with biomechanical modeling in a phylogenetic context provides novel insight into the evolutionary patterns and ecological role of muscle subdivisions in triggerfishes. J. Morphol. 277:737-752, 2016. © 2016 Wiley Periodicals, Inc. PMID:26997352

  10. Nonmetric Skull Divergence in the Otter - Assessing Genetic Insulation of Populations

    OpenAIRE

    Stubbe, M; Ansorge, H.

    1995-01-01

    The craniometric variation and non-metric skull divergence between populations of the otter Lutra lutra (Linné, 1758) were studied using more than 430 skulls from different regions of Eastern Germany. No direct regional differences in skull measurements could be established for this area. The comparison of the morphological variation by non-metric skull characters adduces not or unimportant differentiations for most regions. Otter populations with greater geographic distances have partly high...

  11. Country of my skull/Skull of my country: Krog and Zagajewski, South Africa and Poland

    Directory of Open Access Journals (Sweden)

    P. van Schalkwyk

    2006-07-01

    Full Text Available In the ninth poem of the cycle “land van genade en verdriet” (“country of grace and sorrow” in the collection “Kleur kom nooit alleen nie” (“Colour never comes on its own”, Antjie Krog contends that the old is “stinking along” ever so cheerfully/ robustly in the new South African dispensation. This could also hold true for the new democratic Poland. Krog and the Polish poet Adam Zagajewksi could, in fact, be described as “intimate strangers”, specifically with regard to the mirrored imagery of “country of my skull”/“skull of my country” present in their work. The notion of “intimate strangers” may be seen as pointing toward the feminine dimension of subjectivity, which could be elaborated along the lines of Bracha Ettinger’s concept of “matrixial borderlinking”. Ettinger has made a significant contribution to the field of psychoanalysis, building on Freud and Lacan. She investigates the subject’s relation to the m/Other, and the intimate matrixial sharing of “phantasm”, “jouissance” and trauma among several entities. Critical of the conventional “phallic” paradigm, Ettinger turns to the womb in exploring the “borderlinking” of the I and the non-I within the matrix (the psychic creative “borderspace”. With these considerations as point of departure, and with specific reference to the closing poem in Krog’s “Country of my skull” and Zagajewski’s “Fire” (both exploring “weaning” experiences in recent personal and public history, I intend to show how the public/political is connected to the personal/psychological, and vice versa, and how committed literary works like those of Krog and Zagajewski can be clarified further from a psychoanalytical perspective. The image of the skull in the texts under scrutiny is investigated with recourse to the Lacanian notion of the “cavity”, as adopted and adapted by Ettinger. True to the mirror experience as described within

  12. Blunt force trauma to skull with various instruments.

    Science.gov (United States)

    Sulaiman, Nur Amirah; Osman, Khairul; Hamzah, Noor Hazfalinda; Amir, Sri Pawita Albakri

    2014-04-01

    Deaths due to blunt force trauma to the head as a result of assault are some of the most common cases encountered by the practicing forensic pathologist. Previous studies have shown inflicting injury to the head region is one of the most effective methods of murder. The important factors that determine severity of trauma include the type of weapon used, type and site of skull fracture, intracranial haemorrhage and severity of brain injury. The aim of this study was to determine the characteristics of blunt force trauma to the skull produced by different instruments. Nine adult monkeys (Macaca fascicularis) skulls were used as models. Commonly found blunt objects comprising of Warrington hammer, hockey stick and open face helmet were used in this study. A machine calibrated force generator was used to hold the blunt object in place and to hit the skulls at forces of 12.5N and 25N. Resultant traumatic effects and fractures (linear, depressed, basilar, comminuted, and distastic) were analyzed according to type of blunt object used; surface area of contact and absolute force (N/cm(2)) delivered. Results showed that all investigated instruments were capable of producing similar injuries. The severity of trauma was not related to the surface area of contact with the blunt objects. However, only high absolute forces produced comminuted fractures. These findings were observational, as the samples were too small for statistical conclusions. PMID:24763233

  13. Intraosseous cystic cavernous angioma with occipital skull osteolysis

    Directory of Open Access Journals (Sweden)

    Sakyo Hirai, MD

    2014-09-01

    Full Text Available Intraosseous cavernous angiomas (CAs of the skull are rare, and those cases that appear are commonly localized in the frontal bone. Computed tomography (CT and Magnetic resonance imaging (MRI typically show a well-defined intradiploic lytic mass with homogeneous enhancement. We describe an intraosseous cystic CA of the occipital skull in a 46-year-old man who presented with transient right-sided deafness and posterior cervical pain. MRI revealed a large (3.7 cm × 3.2 cm × 4.1 cm extra-axial tumor, compressing the right cerebellar hemisphere, with heterogeneous peripheral enhancement. A CT scan showed osteolytic change of the occipital skull. The tumor was totally resected via a suboccipital approach. Intraoperatively, we found a mainly cystic tumor containing xanthochromic fluid. Histologically, the tumor was diagnosed as a cavernous angioma. This is the first reported case of an intraosseous CA of the skull with cyst formation. The characteristic radiological imaging of the presented case mimicked a malignant tumor with peripheral enhancement and prominent osteolytic change.

  14. Reliability of Craniofacial Superimposition Using Three-Dimension Skull Model.

    Science.gov (United States)

    Gaudio, Daniel; Olivieri, Lara; De Angelis, Danilo; Poppa, Pasquale; Galassi, Andrea; Cattaneo, Cristina

    2016-01-01

    Craniofacial superimposition is a technique potentially useful for the identification of unidentified human remains if a photo of the missing person is available. We have tested the reliability of the 2D-3D computer-aided nonautomatic superimposition techniques. Three-dimension laser scans of five skulls and ten photographs were overlaid with an imaging software. The resulting superimpositions were evaluated using three methods: craniofacial landmarks, morphological features, and a combination of the two. A 3D model of each skull without its mandible was tested for superimposition; we also evaluated whether separating skulls by sex would increase correct identifications. Results show that the landmark method employing the entire skull is the more reliable one (5/5 correct identifications, 40% false positives [FP]), regardless of sex. However, the persistence of a high percentage of FP in all the methods evaluated indicates that these methods are unreliable for positive identification although the landmark-only method could be useful for exclusion. PMID:26335587

  15. Intracranial hypertension secondary to a skull lesion without mass effect.

    Science.gov (United States)

    Serlin, Yonatan; Benifla, Mony; Kesler, Anat; Cohen, Avi; Shelef, Ilan

    2016-09-01

    We report and discuss five patients with intracranial hypertension due to a skull lesion reducing cerebral sinus patency with a compressive, non-thrombotic mechanism. We illustrate the importance of a high level of suspicion for this condition in patients presenting with headache, papilledema and increased intracranial pressure in the absence of focal signs or radiological evidence of mass effect. PMID:27283387

  16. Reduced skull sexual dimorphism in a local sheep breed

    OpenAIRE

    Parés Casanova, Pere-Miquel

    2014-01-01

    This study estimated the magnitude of sexual dimorphism in a relict sheep from Catalunya (NE Spain), called Fardasca, using geometric morphometric techniques. For these analyses, a total of 18 skull specimens (2 adult males and 16 females) were studied. Our results suggest that the breed is not cranially dimorphic, so sex determination using landmarks described here as criteria is likely to yield poor results.

  17. Morphological Study of Wormian Bones in Dried Human Skulls

    Directory of Open Access Journals (Sweden)

    Divyesh Patel

    2015-09-01

    Full Text Available Background: Wormian bones may be defined as a those accidental bones found in the cranium having no regular relation to their normal ossification centre. They are assocated with cranial and central nervous system abnormalities. Knowledge of these bones is important for anthropo-logists, forensic experts, radiologists, orthopedic and neurosurgeons to avoid misleading for multiple fractures of the skull. Materials and Methods: Adult dry human skulls (n= 27 of unknown age and sex availablein the Department of Anatomy, Govt. Medical College, Surat were included in the study. Result: Overall incidence of wormian bone was 44.4%. They occurred more frequently at lambdoid suture (48.14%.Wormian bones were also presentat asterion (18.5%, along the coronal suture (0.03%, along the parito-temporal suture (0.07%, along the occipito-mastoid suture (0.03%,andat pterion (0.03 %. Wormain bones were found 48.1% on left half of skull and 37.03% on right half of skull. Conclusion: The Wormian bones were more frequent at the lambdoid suture. The clinical importances of these variant bones were emphasized with relevant review of literature. [Natl J Med Res 2015; 5(3.000: 222-225

  18. Anterior knee pain

    International Nuclear Information System (INIS)

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries

  19. Asymmetric activation of the anterior cerebral cortex in recipients of IRECA: Preliminary evidence for the energetic effects of an intention-based biofield treatment modality on human neurophysiology

    NARCIS (Netherlands)

    Pike, C.; Vernon, D.; Hald, L.A.

    2014-01-01

    Neurophysiologic studies of mindfulness link the health benefits of meditation to activation of the left-anterior cerebral cortex. The similarity and functional importance of intention and attentional stance in meditative and biofield therapeutic practices suggest that modulation of recipient anteri

  20. The anterior cingulate cortex

    Directory of Open Access Journals (Sweden)

    Pavlović D.M.

    2009-01-01

    Full Text Available The anterior cingulate cortex (ACC has a role in attention, analysis of sensory information, error recognition, problem solving, detection of novelty, behavior, emotions, social relations, cognitive control, and regulation of visceral functions. This area is active whenever the individual feels some emotions, solves a problem, or analyzes the pros and cons of an action (if it is a right decision. Analogous areas are also found in higher mammals, especially whales, and they contain spindle neurons that enable complex social interactions. Disturbance of ACC activity is found in dementias, schizophrenia, depression, the obsessive-compulsive syndrome, and other neuropsychiatric diseases.

  1. ANTERIOR OSTEOPHYTE IDENTIFICATION IN CERVICAL VERTEBRAE

    Directory of Open Access Journals (Sweden)

    A. T. Chougale

    2011-06-01

    Full Text Available Radiologist always examines X-ray to determine abnormal changes in cervical, lumbar & thoracic vertebrae. Osteophyte (bony growth may appear at the corners of vertebrae so that vertebral shape becomes abnormal. This paper presents the idea from Image processing techniques such as customised Hough transform which will be used for segmentation which should be independent of rotation, scale, noise & shape. This segmented image will be then used for computing size invariant, convex hull based features to differentiate normal cervical vertebrae from cervical vertebrae containing anterior osteophyte. This approach effectively finds anterior osteophytes in cervical vertebrae.

  2. Micrometeorite Impacts in Beringian Mammoth Tusks and a Bison Skull

    Energy Technology Data Exchange (ETDEWEB)

    Hagstrum, Jonathon T.; Firestone, Richard B; West, Allen; Stefanka, Zsolt; Revay, Zsolt

    2010-02-03

    We have discovered what appear to be micrometeorites imbedded in seven late Pleistocene Alaskan mammoth tusks and a Siberian bison skull. The micrometeorites apparently shattered on impact leaving 2 to 5 mm hemispherical debris patterns surrounded by carbonized rings. Multiple impacts are observed on only one side of the tusks and skull consistent with the micrometeorites having come from a single direction. The impact sites are strongly magnetic indicating significant iron content. We analyzed several imbedded micrometeorite fragments from both tusks and skull with laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) and X-ray fluorescence (XRF). These analyses confirm the high iron content and indicate compositions highly enriched in nickel and depleted in titanium, unlike any natural terrestrial sources. In addition, electron microprobe (EMP) analyses of a Fe-Ni sulfide grain (tusk 2) show it contains between 3 and 20 weight percent Ni. Prompt gamma-ray activation analysis (PGAA) of a particle extracted from the bison skull indicates ~;;0.4 mg of iron, in agreement with a micrometeorite ~;;1 mm in diameter. In addition, scanning electron microscope (SEM) images and XRF analyses of the skull show possible entry channels containing Fe-rich material. The majority of tusks (5/7) have a calibrated weighted mean 14C age of 32.9 +- 1.8 ka BP, which coincides with the onset of significant declines<36 ka ago in Beringian bison, horse, brown bear, and mammoth populations, as well as in mammoth genetic diversity. It appears likely that the impacts and population declines are related events, although their precise nature remains to be determined.

  3. Multidisciplinary management of anterior diastemata

    DEFF Research Database (Denmark)

    Furuse, Adilson Yoshio; Herkrath, Fernando José; Franco, Eduardo Jacomino;

    2007-01-01

    Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance the...... aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology and...

  4. Anterior cruciate ligament reconstruction

    International Nuclear Information System (INIS)

    This paper determines the efficacy of MR imaging in evaluation of the anterior cruciate ligament (ACL) following reconstructive surgery. Forty-three MR examinations were performed in 33 patients who had undergone previous arthroscopic ACL reconstruction with patellar bone-tendon- bone autografts (postoperative period, 1-24 months; mean, 5.2 months). Of the 40 studies performed in clinically stable knees (30 patients), MR demonstrated a well-defined, signal void ACL graft in 36. Of the three studies performed in three patients with clinical ACL laxity or suspected tear, the neoligament was of intermediate definition in one and nondiscernible in the other two. As in the native knee, buckling of the PCL was suggestive of ACL insufficiency. Bone tunnel placement, patellar tendon changes, and joint effusions were also evaluated

  5. Anterior hip pain.

    Science.gov (United States)

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity. PMID:10537384

  6. CT-based study of internal structure of the anterior pillar in extinct hominins and its implications for the phylogeny of robust Australopithecus.

    Science.gov (United States)

    Villmoare, Brian A; Kimbel, William H

    2011-09-27

    The phylogeny of the early African hominins has long been confounded by contrasting interpretations of midfacial structure. In particular, the anterior pillar, an externally prominent bony column running vertically alongside the nasal aperture, has been identified as a homology of South African species Australopithecus africanus and Australopithecus robustus. If the anterior pillar is a true synapomorphy of these two species, the evidence for a southern African clade of Australopithecus would be strengthened, and support would be given to the phylogenetic hypothesis of an independent origin for eastern and southern African "robust" australopith clades. Analyses of CT data, however, show that the internal structure of the circumnasal region is strikingly different in the two South African australopith species. In A. africanus the anterior pillar is a hollow column of cortical bone, whereas in A. robustus it is a column of dense trabecular bone. Although Australopithecus boisei usually lacks an external pillar, it has internal morphology identical to that seen in A. robustus. This result supports the monophyly of the "robust" australopiths and suggests that the external similarities seen in the South African species are the result of parallel evolution. PMID:21930932

  7. MR venography in cervical myelopathy before and after direct skull traction

    International Nuclear Information System (INIS)

    MR venography (MRV) was performed to evaluate the anterior cervical venous plexuses in five normal volunteers and eight patients with cervical myelopathy before and after direct skull traction. Visibility of the plexuses from C2 to C7 was evaluated and scored by five observers in those groups. The venography was performed with FISP sequences (fast imaging with steady state precession) and with the injection of Gd-derivatives. The MRV was obtained after maximum-intensity projection and 3D reconstruction. In the normal volunteers, the internal vertebral plexus (IVP), intervertebral vein (IV) and anastomotic vein (AV) were all well demonstrated. In the patients, those plexuses were less well demonstrated in comparison with the normal volunteer, particularly in C5 which is the most frequently affected area. The patient group had lower scores than the normal group. However, the score at C5 was not lower than those at non-affected sites. After treatment, MRV demonstrated those plexuses better in some cases of cervical myelopathy; although this was not evaluated statistically. (author)

  8. MR venography in cervical myelopathy before and after direct skull traction

    Energy Technology Data Exchange (ETDEWEB)

    Sekiguchi, Akira; Enomoto, Kyoko; Kato, Hiroshi [Saitama Medical School, Moroyama (Japan)

    1999-01-01

    MR venography (MRV) was performed to evaluate the anterior cervical venous plexuses in five normal volunteers and eight patients with cervical myelopathy before and after direct skull traction. Visibility of the plexuses from C2 to C7 was evaluated and scored by five observers in those groups. The venography was performed with FISP sequences (fast imaging with steady state precession) and with the injection of Gd-derivatives. The MRV was obtained after maximum-intensity projection and 3D reconstruction. In the normal volunteers, the internal vertebral plexus (IVP), intervertebral vein (IV) and anastomotic vein (AV) were all well demonstrated. In the patients, those plexuses were less well demonstrated in comparison with the normal volunteer, particularly in C5 which is the most frequently affected area. The patient group had lower scores than the normal group. However, the score at C5 was not lower than those at non-affected sites. After treatment, MRV demonstrated those plexuses better in some cases of cervical myelopathy; although this was not evaluated statistically. (author)

  9. A new skull of early Homo from Dmanisi, Georgia.

    Science.gov (United States)

    Vekua, Abesalom; Lordkipanidze, David; Rightmire, G Philip; Agusti, Jordi; Ferring, Reid; Maisuradze, Givi; Mouskhelishvili, Alexander; Nioradze, Medea; De Leon, Marcia Ponce; Tappen, Martha; Tvalchrelidze, Merab; Zollikofer, Christoph

    2002-07-01

    Another hominid skull has been recovered at Dmanisi (Republic of Georgia) from the same strata in which hominid remains have been reported previously. The Dmanisi site dated to approximately 1.75 million years ago has now produced craniofacial portions of several hominid individuals, along with many well-preserved animal fossils and quantities of stone artifacts. Although there are certain anatomical differences among the Dmanisi specimens, the hominids do not clearly represent more than one taxon. We assign the new skull provisionally to Homo erectus (=ergaster). The Dmanisi specimens are the most primitive and small-brained fossils to be grouped with this species or any taxon linked unequivocally with genus Homo and also the ones most similar to the presumed habilis-like stem. We suggest that the ancestors of the Dmanisi population dispersed from Africa before the emergence of humans identified broadly with the H. erectus grade. PMID:12098694

  10. Reconstruction of skull defects in the middle ages and renaissance.

    Science.gov (United States)

    Missori, Paolo; Currà, Antonio; Paris, Harry S; Peschillo, Simone; Fattapposta, Francesco; Paolini, Sergio; Domenicucci, Maurizio

    2015-06-01

    In Egyptian, Greco-Roman, and Arabic medicine, the closure of a skull defect was not provided at the end of a therapeutic trepanation or in cases of bone removal. The literature from the Middle Ages and Renaissance disclosed some striking and forgotten practices. Gilbertus Anglicus (c. 1180 to c. 1250) cites the use of a piece of a cup made from wooden bowl (ciphum or mazer) or a gold sheet to cover the gap and protect the brain in these patients; this citation probably reflected a widely known folk practice. Pietro d'Argellata introduced the use of a fixed piece of dried gourd for brain protection to reconstruct a skull defect. In the late Renaissance, the negative folklore describing this outlandish practice likely led to the use of silver and lead sheets. Nevertheless, for centuries, large numbers of surgeons preferred to leave the dura mater uncovered after bone removal, and failed to apply any brain protection. PMID:25403799

  11. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... and E-poly antioxidant-infused technology during a hip replacement through the anterior supine intramuscular approach. “OR- ... Dr. Keith Berend perform an anterior approach total hip replacement with the patient on a regular OR ...

  12. Study of Interparietal (Inca) bone in dry human skulls

    OpenAIRE

    Janki Jadav; Vaishakhi Gonsai; Ashok Nirvan

    2015-01-01

    Introduction: Squamous part of occipital bone consists of two parts, supraoccipital and interparietal. Interparietal portion may remain separated from the supraoccipital by a suture, it is then called the interparietal bone. Inca population has common manifestation of Interparietal bones, that’s why it is also called ‘Os Inca’ which suggest their ethnic correlation and genetic inheritance. Presence of Inca bone in a skull is great importance to Neurosurgeons, Orthopedic surgeons, Radiologist...

  13. Morphometric Study on Foramen Magnum of Human Skulls

    OpenAIRE

    2013-01-01

    We utilized 100 human skulls to study the morphology and morphometric parameters of the foramen magnum in south Indian population. The anteroposterior diameter and transverse diameter of the foramen magnum were measured by using Vernier calliper to the nearest millimetre. All measurements were tabulated followed by student t” test and descriptive statistics were done in SPSS version to know the p” value for the significance. The mean anteroposterior diameter of foramen magnum in males was...

  14. Streamlined, Inexpensive 3D Printing of the Brain and Skull.

    Directory of Open Access Journals (Sweden)

    Jason S Naftulin

    Full Text Available Neuroimaging technologies such as Magnetic Resonance Imaging (MRI and Computed Tomography (CT collect three-dimensional data (3D that is typically viewed on two-dimensional (2D screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM images to stereolithography (STL files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3-4 in consumable plastic filament as described, and the total process takes 14-17 hours, almost all of which is unsupervised (preprocessing = 4-6 hr; printing = 9-11 hr, post-processing = <30 min. Printing a matching portion of a skull costs $1-5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.

  15. Variation of BMP3 Contributes to Dog Breed Skull Diversity

    OpenAIRE

    Schoenebeck, Jeffrey J.; Hutchinson, Sarah A.; Byers, Alexandra; Beale, Holly C; Carrington, Blake; Faden, Daniel L.; Rimbault, Maud; Decker, Brennan; Kidd, Jeffrey M.; Sood, Raman; Boyko, Adam R.; John W Fondon; Wayne, Robert K.; Bustamante, Carlos D.; Ciruna, Brian

    2012-01-01

    Author Summary As a result of selective breeding practices, modern dogs display a multitude of head shapes. Breeds such as the Pug and Bulldog popularize one of these morphologies, termed “brachycephaly.” A short, upward-pointing snout, a massive and rounded head, and an underbite typify brachycephalic breeds. Here, we have coupled the phenotypes collected from museum skulls with the genotypes collected from dogs and identified five regions of the dog genome that are associated with canine br...

  16. NMR imaging of the facial skull and neck

    International Nuclear Information System (INIS)

    NMR imaging has proved a superior method for the diagnosis of pathological processes in the soft parts of the facial skull and neck, but it is less efficient in the imaging of alterations in the bone tissue as compared to CT. By the use of gadolinium-DTPA, additional information can be obtained on perifocal edemas and irrigation conditions in the area of pathological processes. (orig.)

  17. Directional and fluctuating asymmetries in domestic sheep skulls

    OpenAIRE

    Parés Casanova, Pere-Miquel; Bravi, R.

    2014-01-01

    Morphological symmetry and asymmetry of three different sheep geographical populations (n=39), managed under semi-extensive conditions, were decomposed using geometric morphometric methods, on dorsal aspect of skulls. Fluctuating asymmetry (FA) was used as an indicator of environmental stress, and directional asymmetry (DA) as biomechanical constraints. The two-dimensional coordinates of 21 landmarks were digitized and analyzed using geometric morphometrics. Multivariate analyses show ed the ...

  18. Directional and fluctuating asymmetries in domestic pig skulls

    OpenAIRE

    Parés Casanova, Pere-Miquel; Esteve-Puig, C.

    2014-01-01

    Morphological symmetry and asymmetry of skulls of domestic pig (n=29) were studied using geometric morphometric (GM) methods on the ventral aspect. Fluctuating asymmetry (FA) was used as an indicator of environmental stress, and directional asymmetry as a biomechanical constraint. The two-dimensional coordinates of 27 landmarks were digitized and analysed using GM. Multivariate analyses showed the presence of subtle but significant FA in the entire sample, and distinctive differences were det...

  19. Correlation of petrous bone convergence angle and slope of its walls with dimensional skull characteristics of human craniotypes

    OpenAIRE

    Rossoshanskiy D.N.; Hurchak U.A.; Anisimov A.N.; Aleshkina О. U.

    2012-01-01

    The aim. The purpose of this paper is to study the correlation between the angles of convergence and slope of the pyramids of the temporal bone and linear and angular parameters of the cranial depending on the basilar angle. Materials and Methods. Material study is based on 100 skulls of adult humans, divided into three craniotypes. The method of measurement were made craniotopometric these parameters with further calculation of average value...

  20. Preliminary report: The Little Skull Mountain earthquake, June 29, 1992

    International Nuclear Information System (INIS)

    The Little Skull Mountain earthquake occurred about 20 km from the potential high level nuclear repository at Yucca Mountain. The magnitude was 5.6, and the focal mechanism indicates normal faulting on a northeast trending structure. There is evidence that the earthquake was triggered by the magnitude MS = 7.5 earthquake in Landers, California, which occurred less than 24 hours earlier. Preliminary locations of the hypocenter and several aftershocks define an L shaped pattern near the southern boundary of the Nevada Test Site. One arm trends to the northeast beneath Little Skull Mountain, and a shorter, more diffuse zone trends to the southeast. The aftershocks are mostly located at depths between 7 km and 11 km, and may suggest a southeast dipping plane. There is no clear correlation with previously mapped surface faulting. The strongest recorded acceleration is about 0.21 g at Lathrop Wells, Nevada, 15 km from the epicenter. An extensive network of aftershock recorders was installed by the Seismological Laboratory, University of Nevada, Reno, by the US Geological Survey, Golden, Colorado, and by Lawrence Livermore Laboratory, Livermore, California. Aftershock experiments are ongoing as of November, 1992, and include experiments to improve location, depth, focal mechanism, and stress drop, study basin and ridge response near the epicenter and at Midway Valley, and study response of a tunnel at Little Skull Mountain. Analysis of this data, which includes thousands of aftershocks, has only begun

  1. Psychological Aspects of Anterior Cruciate Ligament Injuries

    OpenAIRE

    Ardern, Clare; Kvist, Joanna; Webster, Kate E.

    2016-01-01

    Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of...

  2. Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

    Energy Technology Data Exchange (ETDEWEB)

    Maroldi, Roberto; Ambrosi, Claudia; Farina, Davide [University of Brescia, Department of Radiology, Brescia, BS (Italy)

    2005-03-01

    Extra-axial intracranial metastases may arise through several situations. Hematogenous spread to the meninges is the most frequent cause. Direct extension from contiguous extra-cranial neoplasms, secondary invasion of the meninges by calvarium and skull base metastases, and migration along perineural or perivascular structures are less common. Leptomeningeal invasion gives rise to tumour cell dissemination by the cerebrospinal fluid (CSF), eventually leading to neoplastic coating of brain surfaces. Contrast-enhanced magnetic resonance (MR) imaging is complementary to CSF examinations and can be invaluable, detecting up to 50% of false-negative lumbar punctures. MR findings range from diffuse linear leptomeningeal enhancement to multiple enhancing extra-axial nodules, obstructive communicating and non-communicating hydrocephalus. Both calvarial and epidural metastases infrequently transgress the dura, which acts as a barrier against tumour spread. Radionuclide bone studies are still a valuable screening test to detect bone metastases. With computed tomography (CT) and MR, bone metastases extending intracranially and primary dural metastases show the characteristic biconvex shape, usually associated with brain displacement away from the inner table. Although CT is better in detecting skull base erosion, MR is more sensitive and provides more detailed information about dural involvement. Perineural and perivascular spread from head and neck neoplasms require thin-section contrast-enhanced MR. (orig.)

  3. Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

    International Nuclear Information System (INIS)

    Extra-axial intracranial metastases may arise through several situations. Hematogenous spread to the meninges is the most frequent cause. Direct extension from contiguous extra-cranial neoplasms, secondary invasion of the meninges by calvarium and skull base metastases, and migration along perineural or perivascular structures are less common. Leptomeningeal invasion gives rise to tumour cell dissemination by the cerebrospinal fluid (CSF), eventually leading to neoplastic coating of brain surfaces. Contrast-enhanced magnetic resonance (MR) imaging is complementary to CSF examinations and can be invaluable, detecting up to 50% of false-negative lumbar punctures. MR findings range from diffuse linear leptomeningeal enhancement to multiple enhancing extra-axial nodules, obstructive communicating and non-communicating hydrocephalus. Both calvarial and epidural metastases infrequently transgress the dura, which acts as a barrier against tumour spread. Radionuclide bone studies are still a valuable screening test to detect bone metastases. With computed tomography (CT) and MR, bone metastases extending intracranially and primary dural metastases show the characteristic biconvex shape, usually associated with brain displacement away from the inner table. Although CT is better in detecting skull base erosion, MR is more sensitive and provides more detailed information about dural involvement. Perineural and perivascular spread from head and neck neoplasms require thin-section contrast-enhanced MR. (orig.)

  4. Evaluation of inverse methods and head models for EEG source localization using a human skull phantom

    International Nuclear Information System (INIS)

    We used a real-skull phantom head to investigate the performances of representative methods for EEG source localization when considering various head models. We describe several experiments using a montage with current sources located at multiple positions and orientations inside a human skull filled with a conductive medium. The robustness of selected methods based on distributed source models is evaluated as various solutions to the forward problem (from the sphere to the finite element method) are considered. Experimental results indicate that inverse methods using appropriate cortex-based source models are almost always able to locate the active source with excellent precision, with little or no spurious activity in close or distant regions, even when two sources are simultaneously active. Superior regularization schemes for solving the inverse problem can dramatically help the estimation of sparse and focal active zones, despite significant approximation of the head geometry and the conductivity properties of the head tissues. Realistic head models are necessary, though, to fit the data with a reasonable level of residual variance. (author)

  5. Mechanical characterization of bone anchors used with a bone-attached, parallel robot for skull surgery.

    Science.gov (United States)

    Kobler, Jan-Philipp; Prielozny, Lenka; Lexow, G Jakob; Rau, Thomas S; Majdani, Omid; Ortmaier, Tobias

    2015-05-01

    Bone-attached robots and microstereotactic frames, intended for deep brain stimulation and minimally invasive cochlear implantation, typically attach to a patient's skull via bone anchors. A rigid and reliable link between such devices and the skull is mandatory in order to fulfill the high accuracy demands of minimally invasive procedures while maintaining patient safety. In this paper, a method is presented to experimentally characterize the mechanical properties of the anchor-bone linkage. A custom-built universal testing machine is used to measure the pullout strength as well as the spring constants of bone anchors seated in four different bone substitutes as well as in human cranial bone. Furthermore, the angles at which forces act on the bone anchors are varied to simulate realistic conditions. Based on the experimental results, a substitute material that has mechanical properties similar to those of cranial bone is identified. The results further reveal that the pullout strength of the investigated anchor design is sufficient with respect to the proposed application. However, both the measured load capacity as well as the spring constants vary depending on the load angles. Based on these findings, an alternative bone anchor design is presented and experimentally validated. Furthermore, the results serve as a basis for stiffness simulation and optimization of bone-attached microstereotactic frames. PMID:25771430

  6. Spontaneous extradural hemorrhage due to Langerhans cell histiocytosis of the skull in a child: A rare presentation

    Science.gov (United States)

    Bakhaidar, Mohamad G.; Alghamdi, Fahad A.; Baeesa, Saleh S.

    2016-01-01

    Eosinophilic granuloma (EG) represents a local form of Langerhans cell histiocytosis that occurs mostly in children. It usually presents with a gradually enlarging painless skull mass, and rarely presents a rapid clinical deterioration. This 7-year-old boy who was diagnosed with EG, based on a magnetic resonance imaging scan, after presenting with a painless right parietal swelling of 7-week duration. Three weeks prior his scheduled surgery, he presented to the emergency department with a 2-day history of sudden increased of the subcutaneous swelling associated with a headache, vomiting, and decreased the level of consciousness; there was no history of trauma. Brain computed tomography revealed a right parietal bone defect with large subgaleal and extradural hematoma. He underwent emergent surgical excision of the skull lesion and evacuation of the hematoma. Histopathological examination confirmed the diagnosis of EG. We aim to raise the awareness of physicians of this rare spontaneous hemorrhagic complication of EG and review the literature. PMID:27195034

  7. Spontaneous extradural hemorrhage due to Langerhans cell histiocytosis of the skull in a child: A rare presentation.

    Science.gov (United States)

    Bakhaidar, Mohamad G; Alghamdi, Fahad A; Baeesa, Saleh S

    2016-01-01

    Eosinophilic granuloma (EG) represents a local form of Langerhans cell histiocytosis that occurs mostly in children. It usually presents with a gradually enlarging painless skull mass, and rarely presents a rapid clinical deterioration. This 7-year-old boy who was diagnosed with EG, based on a magnetic resonance imaging scan, after presenting with a painless right parietal swelling of 7-week duration. Three weeks prior his scheduled surgery, he presented to the emergency department with a 2-day history of sudden increased of the subcutaneous swelling associated with a headache, vomiting, and decreased the level of consciousness; there was no history of trauma. Brain computed tomography revealed a right parietal bone defect with large subgaleal and extradural hematoma. He underwent emergent surgical excision of the skull lesion and evacuation of the hematoma. Histopathological examination confirmed the diagnosis of EG. We aim to raise the awareness of physicians of this rare spontaneous hemorrhagic complication of EG and review the literature. PMID:27195034

  8. Experimental Study of the Protrusion of the Dura Mater at Skull-base Defects%颅底骨缺损硬脑膜膨出的实验研究

    Institute of Scientific and Technical Information of China (English)

    宋冬雷; 丁祖荣; 周良辅; 李士其

    2001-01-01

    目的:建立颅底缺损硬脑膜膨出量评估公式,为临床颅底缺损重建提供科学实验依据。方法:通过力学蠕变挠度分析,得到预计硬脑膜膨出量的力学计算公式,设计相应的力学模拟实验和动物实验加以验证。结果:力学模拟实验及动物实验证明通过力学分析得到的公式是基本正确的。结论:我们建立的颅底骨缺损硬脑膜膨出量评估公式,可以用来预测硬脑膜及其替代物膨出量的动态变化。%Aim:To establish the biomechanical assessment formula that predicts protrusion ofthe dura mater at the cranial base bone defect, and provide scientific experimental basis for cranial base defect reconstruction. Methods: The biomeehanical formula is established by using the creep reflecton analysis and validated by the simulated test and animal expeximents. Results: The simulated test and animal experiments reveal that biomechanical formula is right. Conclusion: The biomechanical formula can be used to predict the dynamic change of protrusion of the dura mater as well as its substitutes at different sizes of cranial base bone defects.

  9. Human skulls with turquoise inlays: pre hispanic origin or replicas?; Craneos humanos con teselas de turquesa: origen prehispanico o replicas?

    Energy Technology Data Exchange (ETDEWEB)

    Silva V, Y. [FIME-UANL, Pedro A. del Alba s/n, Ciudad Universitaria, San Nicolas de los Garza, Nuevo Leon (Mexico); Castillo M, M.T.; Bautista M, J.P. [DRPMZA/INAH. Direccion de Registro Publico de Monumentos y Zonas Arqueologicas, Victoria 110, Copilco El Bajo, 04340 Mexico D.F. (Mexico); Arenas A, J. [IFUNAM, Circuito de la Investigacion Cientifica s/n, Ciudad Universitaria, 04510 Mexico D.F. (Mexico)]. e-mail: ysilva@fisica.unam.mx

    2006-07-01

    The lack of archaeological context determining if the manufacture of two human skulls adorned with turquoise inlays have pre-Columbian origin or not (replicas), led to perform other studies. Under these conditions, besides orthodox methodology commonly used to assign chronology and cultural aspects as form, style, decoration, iconography, etc., it was necessary to obtain more results based on the use of characterization techniques. The techniques employed were Scanning Electron Microscopy (SEM), X-Ray Energy Dispersive Spectroscopy (EDS), Transmission Electron Microscopy (TEM) and Fourier Transform Infrared Spectroscopy (FTIR), in order to determine the manufacture techniques and chemical composition of the materials used for the cementant. SEM analysis showed the presence of zones composed by Ca, O, C and Al. In some cases Mg, Cl, Fe and Pb were identified. High concentration of Cu was present in all samples, due to residues of turquoise inlays (CuAI{sub 6}(PO{sub 4}){sub 4}(OH){sub 8}(H{sub 2}O){sub 4}) with which the skulls were decorated. In the cementant was identified the Ca as base element of the cementant, as well as particles < 100 nm with irregular morphology and other amorphous zones. FTIR spectrums indicated the presence of organic substances that could be used as agglutinating in the cementant. The current work shows a progress identifying involved techniques in the manufacturing of two human skulls with turquoise inlays. (Author)

  10. Demonstration of skull bones mobility using optical methods: practical importance in medicine

    Science.gov (United States)

    Zakharov, Alexander V.; Okushko, Vladimir R.; Vturin, Sergey A.; Moseychuk, Vladimir V.; Petrov, Aleksey A.; Suetenkov, Dmitry E.

    2014-01-01

    Unprompted skull bones mobility not related to breathing, heart beating and other physiological reactions, using installation of original construction with control of physiological parameters by biofeedback hardware-software complex BOS-lab and BOS-pulse appliance (COMSIB, Novosibirsk, Russia) has been confirmed. Teeth eruption occurs through odontiasis canals, emerging from the funiculus. The main driving force for promoting a tooth into odontiasis canal during eruption is the unprompted skull bones mobility. A simple optical installation was made for the visualization of skull bones mobility during the investigation of the median palatine and incisors sutures. Early detection of failures of unprompted skull bones mobility and its normalization can lead to prevention of impact teeth, malocclusion, extrudocclusion and other anomalies and deformations of teeth, teeth rows, TMJ and skull. The skull bones mobility should be considered during the early preventive treatment and therapy of the consequences of injuries and malfunction of the maxillofacial area.

  11. Through Skull Fluorescence Imaging of the Brain in a New Near-Infrared Window

    CERN Document Server

    Hong, Guosong; Chang, Junlei; Antaris, Alexander L; Chen, Changxin; Zhang, Bo; Zhao, Su; Atochin, Dmitriy N; Huang, Paul L; Andreasson, Katrin I; Kuo, Calvin J; Dai, Hongjie

    2014-01-01

    To date, brain imaging has largely relied on X-ray computed tomography and magnetic resonance angiography with limited spatial resolution and long scanning times. Fluorescence-based brain imaging in the visible and traditional near-infrared regions (400-900 nm) is an alternative but currently requires craniotomy, cranial windows and skull thinning techniques, and the penetration depth is limited to 1-2 mm due to light scattering. Here, we report through-scalp and through-skull fluorescence imaging of mouse cerebral vasculature without craniotomy utilizing the intrinsic photoluminescence of single-walled carbon nanotubes in the 1.3-1.4 micrometre near-infrared window. Reduced photon scattering in this spectral region allows fluorescence imaging reaching a depth of >2 mm in mouse brain with sub-10 micrometre resolution. An imaging rate of ~5.3 frames/s allows for dynamic recording of blood perfusion in the cerebral vessels with sufficient temporal resolution, providing real-time assessment of blood flow anomaly...

  12. Vacuum extraction as a treatment modality of neonatal skull depression in twin infant

    International Nuclear Information System (INIS)

    The management of depressed skull fractures in the newborn infant can be controversial. In this article, we report a case of twin pregnancy wherein one of the fetuses had depressed skull fractures that was not associated with any known trauma during the pregnancy or at delivery. This ping-pong skull depression was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible etiologies and treatment modalities for neonatal depressed fractures, being conservative or operative, are discussed. (author)

  13. Anterior Decompression and Anterior Instrumentation of Tuberculosis of Cervicothoracic Spine by Cervicomanubrial Approach

    Directory of Open Access Journals (Sweden)

    Anant Kumar Garg

    2012-04-01

    Full Text Available Background: Evaluation of result of anterior cervical approach with manubriotomy and anterior instrumentation in tuberculosis of cervicothoracic spine in terms of the neurological recovery, reconstruction of spine and prevention of deformity along with relief of pain. Materials and Methods: All five patients with cervicothoracic caries spine had surgery through anterior cervical approach with manubriotomy in our hospital and underwent excision of the involved vertebrae and intervertebral discs followed by anterior spinal reconstruction with titanium spacer cage filled with cancellous iliac crest bone graft and Orion plate with locking screw. Antitubercular drugs were administered for 12 months. The follow-up period ranged from 12 to 36 months. Results: Analysis of result was done on the basis of clinical and radiological criteria. Clinical assessment based on Frankel grade and modified JOA score showed significant improvement from preoperative findings. Radiological assessment showed osteointegration, no spinal instability and no progression of the deformity. The pain control, based on visual analog scale changed from a pre-operative average of 7.5 to 2 at the last follow-up thereby indicating significant improvement and all patients returned to preoperative functional status. One patient had transient hoarseness of voice. No other complication had been encountered in the immediate post operative and during the follow-up period. Conclusions: Our study showed that anterior cervical approach with manubriotomy and anterior insertion of titanium cage, filled with autogenous bone graft, secured with locking plate instrumentation has a successful role in the eradication of infection, neurological recovery, segmental spinal reconstruction and it also reduces surgical time, blood loss, and surgical complications and approach related comorbidity in follow up period. Level of Evidence- Level 4, Case series

  14. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... Taperloc Microplasty stem and E-poly antioxidant-infused technology during a hip replacement through the anterior supine ... renewed interest at this time due to several advantages that it brings. The approach that is performed ...

  15. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... an anterior approach total hip replacement with the patient on a regular OR table supine. My name ... less invasive without being small incision surgery. Obese patients can be easier due to less distribution of ...

  16. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... it to have any real negative or deleterious effect by removing the anterior capsule. Now I would ... is what happens with one of the competitive designs. Like I told you, I just take a ...

  17. Anterior approach for knee arthrography

    International Nuclear Information System (INIS)

    Objective. To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy.Design. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected.Results and conclusion. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort. (orig.)

  18. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

    Directory of Open Access Journals (Sweden)

    Ai Hosaka

    2015-01-01

    Full Text Available Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

  19. Travoprost Induced Granulomatous Anterior Uveitis

    OpenAIRE

    Patrick Chiam

    2011-01-01

    Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was att...

  20. Update on anterior ankle impingement

    OpenAIRE

    Vaseenon, Tanawat; Amendola, Annunziato

    2012-01-01

    Anterior ankle impingement results from an impingement of the ankle joint by a soft tissue or osteophyte formation at the anterior aspect of the distal tibia and talar neck. It often occurs secondary to direct trauma (impaction force) or repetitive ankle dorsiflexion (repetitive impaction and traction force). Chronic ankle pain, swelling, and limitation of ankle dorsiflexion are common complaints. Imaging is valuable for diagnosis of the bony impingement but not for the soft tissue impingemen...

  1. Radiographic study on the anterior portion of the neck of the condylar process. Aged-related developmental changes based on Hellman's dental stage

    International Nuclear Information System (INIS)

    The condylar process is directly and indirectly influenced by the masticatory muscles and the temporomandibular joint, which functions to regulate jaw movement. Age-related changes in the condylar process were found in both external and internal structures. Observation of X-ray profiles afforded identification of areas of interest in the anterior portion of the neck of condylar process. This portion anatomically includes the pterygoid fovea; moreover, the process serves as a terminal for the lateral pterygoid muscle. Rather than directly analyzing bone structure, we made distinct measurements in regions of interest by X-ray image analysis. Subsequently, changes in occlusion during each developmental stage were evaluated. In addition, bone mineral density measurements were performed. Greater growth was recognized in the long axis of the condylar process in comparison to the short axis. The long axis indicated a 2.7-fold increase in ODL (length along the major axis) from the IA period to the VA period; additionally, the total absolute length increased by 3.1-fold. The short axis demonstrated a 2.3-fold increase in ODS (length along the minor axis) from the IA period to the VA period; furthermore, the total average length revealed a 1.9-fold increase. Bone mineral density was highest in the anterior portion (region of interest) and was higher in the posterior portion (cortical bone); than in the middle portion (central bone). Among these 3 areas, density differences became larger as the developmental stage of occlusion progressed. Detailed measurements in the region of interest demonstrated significant increases from the IIC period to the IIIA (B) period, and distinct peak times of increases were observed in bone mineral density: the center bone structure, as well as the posterior cortical bone, showed significant increases between the IIIC period and the IVA period. The anterior border displayed to constant increase with an exception for the period between stages

  2. Anterior chamber depth during hemodialysis

    Directory of Open Access Journals (Sweden)

    Gracitelli CPB

    2013-08-01

    Full Text Available Carolina Pelegrini Barbosa Gracitelli,1 Francisco Rosa Stefanini,1 Fernando Penha,1 Miguel Ângelo Góes,2 Sérgio Antonio Draibe,2 Maria Eugênia Canziani,2 Augusto Paranhos Junior1 1Ophthalmology Department, 2Division of Nephrology, Federal University of São Paulo – UNIFESP, São Paulo, Brazil Background: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD because of anterior chamber depth changes during this therapy. Purpose: To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results: There was no difference in the axial length between the three measurements (P = 0.241. We observed a significantly decreased anterior chamber depth (P = 0.002 during HD sessions. Conclusion: Our results support the idea that there is a change in anterior chamber depth in HD sessions. Keywords: anterior chamber, hemodialysis, axial length, acute angle-closure glaucoma

  3. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... With a minimally invasive technique, there is less disruption of tissues. It keeps anatomy close to normal ... which is a tumor of the normal pituitary cells that just grows out of control. And we' ...

  4. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... what's above us is what we call the roof of the sphenoid sinus, or the planum. 00: ... the image guidance. The tumor is highlighted in green and you can plan different trajectories to it ...

  5. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... MD: Okay, the -- has any of the more superior tumor started to deliver itself down into the ... fibrin glue. There are some other commercially available products that are used as sealants in and around ...

  6. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... a history of hypertension, diabetes, high cholesterol, and anemia. He's had previous cardiac surgery and carotid artery ... present at a much smaller size and the abnormality is discovered -- discovered on blood tests. We -- we ...

  7. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... small one to the right side. To the left. This is good, yeah. 01:13:01 JOSEPH L. KOEN, MD: So there to the right of the screen, I believe we're actually looking into the brain space, or technically the subarachnoid space, inside that ...

  8. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... had presented some time ago with headache and visual lost. The patient went to his ophthalmologist, who documented loss of visual fields, loss of visual acuity, and he astutely ...

  9. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... of all brain tumors that come to clinical attention. The way that pituitary tumors typically present is ... large size oftentimes before they come to clinical attention. And again, the most common symptoms are loss ...

  10. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... pituitary described as the master gland of the human body, and that's a very good name for ... things at different times, and it's really a teamwork approach. And it works very well. 00:39: ...

  11. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... nasal splints and nasal packing for about five days, which is the routine for the traditional approach. ... invasive. It is a very common term these days, minimally invasive techniques are becoming more and more ...

  12. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... show what it looks like with just the CAT scan? And so that's what it looks like with the CAT scan, and you have a hard time telling ... but with an MRI fused in with a CAT scan, you can see that much better. Joe, ...

  13. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... screen and open the door to informed medical care. Now let's join the doctors. 00:00:58 ... likely to get that, unless it's appropriately taken care of during the time of the surgery to ...

  14. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... anatomic structures were. But with what we call dynamic scoping, you know, pushing in and out with ... is some loss of depth perception, but with dynamic scoping, like was mentioned, tactile feedback, that is ...

  15. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... slides here, we'll talk about our patient history for a few moments. Our patient today is ... 71-year-old male. He does have a history of hypertension, diabetes, high cholesterol, and anemia. He's ...

  16. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... around the pituitary comprise about 10% of all brain tumors that come to clinical attention. The way that ... re able to see the normal tumor or cancer interface. And so here ... started going into the brain and went up pretty high. And normally this ...

  17. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... to learn more. Just click on the "Request Information" button on your webcast screen and open the ... to learn more. Just click on the "Request Information" button on your webcast screen and open the ...

  18. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... t been able to show that because the risk of the surgery is pretty low, so you ... and you can even get sinus infection. The risk of developing a sinus infection is about anywhere ...

  19. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... system, it makes the operation safer. Technically, we haven't been able to show that because the ... 14:17 JOSEPH K. HAN, MD: No, we haven't seen the optic nerve yet, because I ...

  20. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... artery surgery as well. He had presented some time ago with headache and visual lost. The patient ... the CAT scan, and you have a hard time telling where the tumor is at. But if ...

  1. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... to informed medical care. Now let's join the doctors. 00:00:58 JOSEPH L. KOEN, MD: Good ... colleagues Dr. Joseph Han, who is an ENT physician at Eastern Virginia Medial School, as well as ...

  2. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... an idea of how deep things are. Another feedback that we get is the tactile sensation. So ... to your other structures, so with those two feedbacks, you're able to overcome that -- that depth ...

  3. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... had nasal splints and nasal packing for about five days, which is the routine for the traditional ... of a small lemon, only 6 centimeters by 5 centimeters by 3 centimeters, and so we're ...

  4. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... pituitary described as the master gland of the human body, and that's a very good name for ... 2007. And I think that just shows the evolution of the technique. There is a bit of ...

  5. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... is an ENT physician at Eastern Virginia Medial School, as well as Dr. Vijai Singh, who is ... head and neck surgeon at Eastern Virginia Medical School. As well as Dr. Vijai Singh, who is ...

  6. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... image guidance system, it's -- we're using a CT and MRI together, and we've fused it together so we can get a better look at the tumor, and so, Allison, can you show what it looks like with just the CAT scan? And so that's what it looks like with ...

  7. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... here we're actually working in the cavernous sinus right here. And we're working off on ... side. So there's tumor eviding into the cavernous sinus, as you guys saw on the MRI, and ...

  8. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... The brain here is this gray structure, these black structures are the ventricles, very normal-looking. The ... show you that here. On the normal, this black structure is the carotid artery actually on the ...

  9. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... pituitary described as the master gland of the human body, and that's a very good name for ... was mentioned, tactile feedback, that is a learned skill, and you can easily tell the depth of ...

  10. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... MD: I think they're involved there with something. 00:45:59 JOSEPH K. HAN, MD: I ... then -- and so -- and so -- so -- but for something like this, where you have to go past ...

  11. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... see there now. It's starting to look very clean back there. 00:36:24 RAN VIJAI SINGH, ... now. Everything else looks very nice and very clean. And if we were to open that thin ...

  12. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... minimally invasive technique, there is less disruption of tissues. It keeps anatomy close to normal on the ... so it's very, very adherent to the surrounding tissues. So we are trying to establish a plane ...

  13. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... comes across pretty well. And that's a nice innovation to use a CT plus an MRI, because ... layer somewhat incompetent, and sometimes you have to open it to remove the tumor. And we'll ...

  14. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... things at different times, and it's really a teamwork approach. And it works very well. 00:39: ... maneuvers. And you can see sort of the teamwork approach here and the setup, and the entire ...

  15. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... was mentioned, tactile feedback, that is a learned skill, and you can easily tell the depth of ... brain will stay at its location with the soft tissue support, then we don't need to ...

  16. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... which is a tumor of the normal pituitary cells that just grows out of control. And we' ... re working just in front of the brain stem here. If you remember the previous MRI, we ...

  17. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... as your thyroid, the thyroid gland, cortisol, the adrenal gland. It also influences the kidney with urine ... right, Joe, is the majority of the pituitary mass is -- or tumors -- most of the pituitary tumors ...

  18. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... there in the live situation? It's normally very soft and pliable, is that what it looks like ... planes as clearly. The tumor kind of looks soft, kind of -- kind of grainy. Soft, grainy feel. ...

  19. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... on. The brain here is this gray structure, these black structures are the ventricles, very normal-looking. ... minimally invasive. It is a very common term these days, minimally invasive techniques are becoming more and ...

  20. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... of visual acuity, and he astutely ordered an MRI scan of the brain. Now, this study showed ... the screen here, you'll see our patient's MRI scan. There are two MRIs. Our patient today ...

  1. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... which is a tumor of the normal pituitary cells that just grows out of control. And we' ... we're working just in front of the brain stem here. If you remember the previous MRI, ...

  2. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... facilities, and over a 300-member physician medical group. The service area is quite large. Sentara serves ... the newer endoscopic approach. Those are the two groups that we looked at. The demographics were very ...

  3. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... OR-Live makes it easy for you to learn more. Just click on the "Request Information" button ... the technique. There is a bit of a learning curve using the endoscope and a certain level ...

  4. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... separates the -- the brain area or the intracranial space from the pituitary gland. And I believe we ... artery, and that would be inside the subarachnoid space proper. Very good pulsations. That's what you want ...

  5. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... Sentara Healthcare is a not-for-profit healthcare system, been in business for 118 years. They have ... how this isn't a regular image guidance system, it's -- we're using a CT and MRI ...

  6. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... and the abnormality is discovered -- discovered on blood tests. We -- we have listed here some other tumors ... likely to get that, unless it's appropriately taken care of during the time of the surgery to ...

  7. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... thyroid gland, cortisol, the adrenal gland. It also influences the kidney with urine output and so forth. ... does not secrete any particular hormone or directly influence any particular hormone level, so those -- those tumors ...

  8. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... to say just a few words about the definition of minimally invasive. It is a very common ... comes across pretty well. And that's a nice innovation to use a CT plus an MRI, because ...

  9. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... kind of -- any kind of tumor resection or cancer resection, what's important is tissue plane. And you ... re able to see the normal tumor or cancer interface. And so here we're actually working ...

  10. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... the surgery about 10 times safer with this technology than without. 00:16:30 JOSEPH L. KOEN, ... while ago, 1963. But of course as the technology has improved, the visualization has become much better. ...

  11. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... have heard of. That produces a hormone that increases the amount of cortisol in the body. Prolactinoma ... HAN, MD: So that way it kind of helps us confirm that -- we kind of knew that ...

  12. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... a not-for-profit healthcare system, been in business for 118 years. They have seven local hospitals, ... t been able to show that because the risk of the surgery is pretty low, so you ...

  13. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... a not-for-profit healthcare system, been in business for 118 years. They have seven local hospitals, ... was mentioned, tactile feedback, that is a learned skill, and you can easily tell the depth of ...

  14. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... 37 JOSEPH K. HAN, MD: Where's the other bipolar? Where's the other bipolar? 00:22:43 JOSEPH L. KOEN, MD: And ... MD: Maybe we can get that with the bipolar. 00:36:48 JOSEPH L. KOEN, MD: Vijai, ...

  15. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... what is not dangerous, and so you can work in that area confidently, knowing that you won't injure anything severe. And so this is some general ... operative time, less bleeding during the operation, less pain after the ... bit about the two surgeons working together, and you're getting a sense of ...

  16. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... a very good name for it. It does control all of the bodily hormones, hormones such as ... so we want to try to -- try to control that and get better exposure. So right what ...

  17. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... to say just a few words about the definition of minimally invasive. It is a very common ... so we want to try to -- try to control that and get better exposure. So right what ...

  18. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... come from the eyes and of course enable vision. So you can see as a tumor grows ... again, the most common symptoms are loss of vision and perhaps headache or pressure behind the eyes. ...

  19. Neurocognitive effects of therapeutic irradiation for base of skull tumors

    International Nuclear Information System (INIS)

    Purpose: To determine whether radiation therapy delivered to the paranasal sinuses causes any long-term impairment in neurocognitive function as a result of incidental brain irradiation. Methods and Materials: Nineteen patients who received paranasal sinus irradiation at least 20 months and up to 20 years before assessment were given a battery of neuropsychologic tests of cognitive function. Radiation was delivered by a three-field (one anteroposterior and two lateral) technique. The median radiation dose was 60 Gy (range 50-68 Gy) in fractions of 1.8 to 2 Gy. The volume of irradiated brain was calculated from planning computed tomography slices or simulation films. The results of the neuropsychologic tests were compared to normative control values. Results: Memory impairment was found in 80% of the patients, and one-third manifested difficulty with visual-motor speed, frontal lobe executive functions, and fine motor coordination. Two of the patients had frank brain necrosis with resultant dementia and blindness, and three had evidence of brain atrophy. Three of the fourteen patients without documented cerebral atrophy or necrosis were disabled from their normal activities. Three patients also developed pituitary dysfunction. Neurocognitive symptoms were related to the total dose of radiation delivered but not to the volume of brain irradiated, side of radiation boost, or chemotherapy treatment. The pattern of test findings was consistent with radiation injury to subcortical white matter. Conclusions: Radiation therapy for paranasal sinus cancer may cause delayed neurocognitive side effects. Currently, however, the development of severe adverse effects appears to be decreasing because of improvements in the techniques used to deliver radiation. Lowering the total dose and improving dose distributions should further decrease the incidence of delayed brain injury due to radiation

  20. Transnasal Endoscopic Surgery for Skull-Based Tumors

    Medline Plus

    Full Text Available ... you can end up with conditions like Cushing's disease, which you may have heard of. That produces ... MD: Maybe we can get that with the bipolar. 00:36:48 JOSEPH L. KOEN, MD: Vijai, ...