Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature.

BACKGROUND: Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously. CASE PRESENTATION: We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free. CONCLUSIONS: An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.

Anterior Atlanto-Occipital Transarticular Screw Fixation: A Radiological Evaluation.

BACKGROUND: In situations in which posterior atlanto-occipital fixation might not be possible or might require supplemental fixation, anterior fixation might add stability in obtaining arthrodesis. The present study aimed to provide a radiographic evaluation of the safety and feasibility in the anterior approach. METHODS: The bilateral craniocervical computed tomography slices of 60 patients were examined. The anterior screw entry point was the lowest point at the middle anterior aspect of C1 (atlas) lateral mass. To avoid hypoglossal canal and craniocerebral injury, the height of the hypoglossal canal and occipital condyle and occipital condyle width were obtained. The mandible occlusion angle (MOA), anterior screw trajectory above, under, and distal to the hypoglossal canal (AHA, UHA, and DHA) relative to the tangent line of C1 front border were measured, together with the maximum screw length under each angle (AHL, UHL and DHL). An independent samples t test was used for statistical analysis. RESULTS: The height of the hypoglossal canal and occipital condyle and occipital condyle width were all larger in the men than in the women. The MOA, AHA, UHA, and DHA were 55.0°, 18.7°, 41.0°, and 55.0°, respectively, and were similar between genders. The AHL, UHL, and DHL were 34.5, 30.9, and 31.3 mm, with the measurements for the men generally longer than those for the women by 3-4 mm. A total of 10 of 120 bilateral measurements showed the possibility of mandible occlusion, and the potential success rate of the anterior approach could reach 91.7%. CONCLUSIONS: The ideal entry angle for anterior atlanto-occipital fixation ranges from 41.0° to 55.0°, with a safe screw length from 30.9 to 31.3 mm. The potential success rate could reach >90%.

A virtual assessment of the proposed suprainiac fossa on the early modern European calvaria from Cioclovina, Romania.

OBJECTIVES: The calvaria from Cioclovina (Romania) has been argued to possess some traits commonly ascribed to individuals belonging to the Neanderthal lineage, including a suprainiac fossa. However, its supranuchal morphology has only been evaluated with a qualitative analysis of the ectocranial surface. We evaluate whether the morphology of the supranuchal area of this specimen is homologous to the Neanderthal condition. MATERIALS AND METHODS: We described in detail the external morphology, and, using computed tomography, investigated the internal morphology of the Cioclovina supranuchal area. We took measurements of the internal structures and calculated their relative contributions to total cranial vault thickness, which were compared to published data and evaluated with a principal component analysis (PCA). RESULTS: The Cioclovina supranuchal region is characterized by superficial resorption present on the outer layer of the external table. Neither the diploic layer nor the external table decrease in relative thickness in the area above inion. In the PCA, Cioclovina falls within the convex hulls of recent modern Homo sapiens. DISCUSSION: Our results show that the morphology of the Cioclovina supranuchal region does not correspond to the external and internal morphology of the typical Neanderthal suprainiac fossa. It cannot be characterized as a depression but rather as an area presenting superficial bone turnover. Together with earlier results, there is little phenotypic evidence that Cioclovina has high levels of Neanderthal ancestry. Our study demonstrates the usefulness of this quantitative method in assessing proposed Neanderthal-like suprainiac depressions in Upper Paleolithic and other fossil specimens.

Unusual osteological findings in sacred relics from the LESJE monastery in central Serbia.

An adult male skeleton was submitted to the Department of Anatomy at the University of Belgrade for evaluation. It was believed to represent the remains of a second to third century Christian saint from the Lesje Monastery in central Serbia. Examination of the remains revealed an old crush fracture of a thoracic vertebra and an unusual, probably congenital, malformation of the atlanto-occipital joint with deformation of the left occipital condyle and resultant narrowing of the foramen magnum. Although the occipital malformations were most likely congenital, they may still have caused, or contributed to, death by compression of the underlying upper cervical spinal cord.

The relationship between dens height and alar ligament orientation: a radiologic study.

OBJECTIVE: This study examined the anatomical assumptions underlying multiplanar alar ligament stress testing. The alar ligament has been described as occurring in 1 of 3 planes: caudocranial, horizontal, and craniocaudal. This has been stated to result from variation in dens height. Stress testing in all 3 planes is suggested, with increased translation present in all positions to infer instability. METHODS: Computed tomography scans with no diagnosed bony or ligamentous abnormally were prospectively collected over a 3-month period from a teaching hospital in Newcastle, Australia, and sequentially analyzed. The height of the dens relative to the occipital condyles was measured using McRae's line and the bimastoid line. The orientation of the alar ligament was measured relative to the vertical axis of the dens as well as a vertical line defined by specified occipital and spinal bony landmarks. These results were correlated with dens height. RESULTS: After exclusions, 42 individual computed tomography studies were analyzed yielding 64 clearly discernible ligaments. A vertical line derived from the digastric line provided the smallest variation in results. The mean ligament orientation given by this measure was 110.06° (85°-127°). There was no correlation between measured dens height relative to the occiput and ligament orientation. CONCLUSION: Our findings reinforce the existence of normal anatomical variation in dens height and alar ligament orientation. However, variation in dens height as a cause of variation in ligament orientation was not supported by this study.

Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report.

The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity. A computed tomography (CT) scan of the cervical spine demonstrated a destructive process involving the odontoid and the left occipitocervical and atlantoaxial joints that was not present on a CT obtained 2 months earlier, just before trigger-point and left-sided C1-2 facet joint corticosteroid injections. A diagnosis of staphylococcal osteomyelitis was made, and initial treatment with external immobilization and appropriate antibiotic therapy failed to control radiographically demonstrated and clinical progression. The patient was successfully treated using staged anterior decompression and posterior instrumented fusion with prolonged antibiotic therapy. To the authors' knowledge this case is the first reported instance of iatrogenic pyogenic osteomyelitis of the craniocervical junction successfully treated with anterior decompression and delayed posterior arthrodesis.

Cranial imaging in autosomal recessive osteopetrosis. Part II. Skull base and brain.

The authors reviewed cranial imaging studies (radiographs, computed tomographic scans, and magnetic resonance [MR] images) in 13 infants and children with the autosomal recessive form of osteopetrosis to characterize patterns of skull base, brain, and cranial nerve involvement at presentation and with progression of disease. Marked sclerosis and deposition of osteopetrotic bone was noted along the anterior (but not posterior) occipitomastoid suture (n = 8), at the basioccipital-exoccipital synchondrosis (n = 9), and along the sphenooccipital synchondrosis (n = 8). Endobones, presumably representing unresorbed primitive ossification centers, were seen in the sphenoidal body and basioccipital bone in 11 of the 13 patients. Marked cupping at the basioccipital-exoccipital synchondrosis was observed in three. Neurologic deficits included blindness (n = 11), conductive hearing loss (n = 11), and facial nerve palsies (n = 4). Delayed myelination was seen with MR imaging in two of five retarded infants, including one with a documented coexisting neuronal storage defect. Prominent extracerebral cerebrospinal fluid spaces were present over the frontal lobes in five of the eight developmentally normal patients, representing either subclinical parenchymal disease or a phenomenon related to discordant growth rates between skull and brain.

[Distribution of mineral salts in structures of the compact substance of human bone]. / Raspredelenie mineral'nykh solei v strukturakh kompaktnogo veshchestva kosti cheloveka.

Mineral distribution has been studied in osteoni and intermediate spaces of the compact substance in fibular and occipital human bones. The material has been taken from 34 corpses. Total mineral content was estimated by the contact microroentgenography technique. Calcium, phosphorus and magnium content and distribution were studied by means of X-ray spectral microanalysis. The results obtained characterized bone morphological structure depending on the degree of their miniralization. Peculiarities in calcium and phosphorus distribution along radius osteoni were studied. Quantitative data were obtained on their content in the bone morphological structures. In spite of uneven distribution of some elements in the bone samples, constant molar Ca/P ratio was noted.