A computed tomography study on the olfactory fossa in dried skulls.

PURPOSE: The computed tomography (CT) study investigates the olfactory fossa (OF) morphometry and morphology. METHODS: Fifty Greek adult dried skulls were macroscopically investigated for the detection of the OF morphological patterns and after a multiplanar CT reconstruction, the OF morphometry was accurately calculated using a digital ruler. RESULTS: Types I and II surface contour patterns were the most frequently identified (36 and 32%), followed by types III, IV, and V (16, 12, and 4%). Crista galli mean length, height, and width were 19.46 ± 2.34 mm, 12.69 ± 2.7 mm, and 5.18 ± 1.11 mm. The OF mean maximum length was 22.29 ± 2.16 mm on the right and 22.10 ± 2.44 mm on the left side, and symmetry was detected. The OF median values of the maximum depth for its anterior, middle, and posterior third were 4.91 mm, 4.72 mm, and 2.78 mm on the right and 4.55 mm, 4.75 mm, and 2.55 mm on the left side. Symmetry was observed in any third of the OF. The OF median values of the surface maximum width for the anterior, middle, and posterior thirds were 9.29 mm, 11.48 mm, and 13.07 mm. A significant gradual increase of the OF surface maximum width was detected in the anteroposterior direction in the total sample (p < 0.001), with the highest value (23.12 mm) in the posterior third. A significant (p < 0.001) very strong (rs = -0.798) and a moderate (rs = -0.524) negative linear correlation in the OF anterior and middle third were, respectively, identified between its maximum depth and width. No gender impact was identified. CONCLUSIONS: The study helps to familiarize with the calculation of the OF dimensions and simplifies the understanding of its complex anatomy, to reach successful surgical planning and minimize perioperative complications.

Atlas posterior arch and vertebral artery's groove variants: a classification, morphometric study, clinical and surgical implications.

BACKGROUND: The third part of the vertebral artery (VA) coursing in vertebral artery groove (VAG) may be injured during posterior craniocervical junction approaches. OBJECTIVE: The current study classifies all possible variants of the posterior arch (PA) of the atlas vertebra (C1), focusing on VAG and calculates their incidence. PA and VAG morphometry is studied in correlation with gender and age. Clinical and surgical implications of recorded variants are provided in an effort to explain associated pathology. The usefulness of three-dimensional computed tomography (3D-CT) in detecting PA variants is highlighted. MATERIALS AND METHODS: Two hundred and forty-four Greek adult dry C1 were classified in types according to PA morphology [i.e. presence of an imprint or a distinct VAG and occurrence of a partially or completely ossified dorsal (PDP or CDP) or lateral (PLP or CLP) ponticle unilaterally or bilaterally]. Combined variants were also included. RESULTS: A VAG and an imprint were detected in 42.62% and 15.16%. A PDP and CDP were observed in 18.03% and 15.98%, while a CLP and PLP in 2.05% and 1.64%, respectively. Combined PDP and PLP were detected in 2.05%, a CDP and CLP similarly to a CDP and PLP in 1.23% and a PDP and CLP in 0.40%. CONCLUSIONS: Variants' classification will contribute to an in depth understanding of the complex C1 anatomy and may explain cases of VA entrapment and injury during PA fixation. Surgeons should carefully study 3D-CT imaging to ensure type, location, size and shape of C1 ponticles in combination with VAG morphology and VA course before screw insertion.

Neurosurgery Training in Greece.

OBJECTIVE: The structure and specifics of neurosurgery residency training vary substantially across programs and countries, potentially leading to differences in clinical reasoning, surgical skills, and professionalism. The Greek neurosurgical training system is unique in numerous respects. This manuscript delineates the current state of neurosurgical residency training in Greece and outlines future directions. METHODS: A narrative review was conducted to describe the Greek neurosurgical residency training structure. The perspectives of the authors regarding challenges in training and future directions were synthesized. RESULTS: This manuscript describes the neurosurgery residency curriculum and board certification process, existing training programs, and key challenges in neurosurgery residency training in Greece. The authors propose future directions to reform neurosurgical training in Greece. CONCLUSIONS: Neurosurgery residency training in Greece has been largely unchanged for many years. This review leads to suggested modification of the existing training process may improve the quality of training and equip neurosurgeons to respond to the rapidly changing landscape of the field.

Cavernous sinus chondroma. Case report and review of the literature.

Chondromas of the base of the skull are most commonly found in the parasellar and sellar regions, and present varying degrees of involvment of the cavernous sinus.However, those confined mainly to the cavernous sinus are rare, and only a few cases have been reported. A 50 year old man experienced left hemifacial pain followed by left abducens nerve palsy. Computerized tomography and magnetic resonance image depicted a well circumscribed mass in the left cavernous sinus. A pterional craniotomy was performed to approach this lesion intradurally. The tumour was subtotally removed Histologically the mass was diagnosed as a mature chondroma. Postoperatively, the left hemifacial pain disappeared and the diplopia improved from the first postoperative day. Successfull removal of lesions in the cavernous sinus requires individualisation of the case as well as choosing the correct surgical approach for the certain patient.