RESUMEN
The need to promote calvaria bone healing as a consequence of injury or craniotomy is a major clinical issue. Previous reports tested recombinant human Jagged1 (rhJagged1) treatment for critical-size calvaria defects in the absence of periosteum, and this resulted in significant new bone formation. As the periosteum contributes to healing by serving as a source of progenitor cells, the present study aimed to examine whether significantly more bone is formed when the periosteum is intact for using rhJagged1 to treat critical-size parietal bone defects in mice. Fifteen healthy adult mice, 34 to 65 weeks of age, 26.9 to 48.2 g, were divided into different groups that compared the critical-size defects treated with either phosphate-buffered saline or rhJagged1 protein in either the presence or absence of periosteum. The results indicated that more bone was formed in the presence of periosteum when rhJagged1 is delivered [35% bone volume per tissue volume (BV/TV); P = 0.02] relative to nonperiosteum. Recombinant human Jagged1 protein delivered in the absence of periosteum had the next most new bone formed (25% BV/TV). Defects with phosphate-buffered saline delivered in the absence or presence of periosteum had the least new bone formed (15% and 18% BV/TV, respectively; P = 0.48). The results also show that rhJagged1 does not form ectopic or hypertrophic bone. The usage of rhJagged1 to treat critical-size defects in calvaria is promising clinically, but to maximize clinical efficacy it will require that the periosteum be intact on the noninjured portions of calvaria.
Asunto(s)
Regeneración Ósea , Proteína Jagged-1 , Periostio , Proteínas Recombinantes , Animales , Proteínas Recombinantes/farmacología , Proteínas Recombinantes/uso terapéutico , Ratones , Regeneración Ósea/efectos de los fármacos , Humanos , Cráneo/cirugía , Cicatrización de Heridas/efectos de los fármacos , Hueso Parietal/cirugía , Masculino , Osteogénesis/efectos de los fármacos , Microtomografía por Rayos XRESUMEN
Intradiploic meningiomas are rare neoplasms, often mistaken for metastases or malignant bone tumors. Surgical management can be challenging, considering their diffusive bony invasion. Two main critical decisions need to be taken: the timing for cranial vault reconstruction and the choice of the adequate material for cranioplasty. We believe that this case underscores the complexity of such lesions, the importance of a prompt devascularization, and the pivotal role of an immediate reconstruction to avoid the additional morbidity of a re-do surgery. Here, we report a case of 68-year-old men who presented with slow growing right parietal bone swelling he noted many years before, but for which he didn't seek medical attentions, associated with mild contralateral hemiparesis. Neuroradiological examinations revealed a giant extradural intradiploic tumor affecting the right temporo-parietal bone and conditioning significant compression of the underlying brain. We planned a surgical strategy to deafferent the tumor and to reduce the intraoperative bleeding. At first, a circumferential craniectomy centered upon the lesion was performed, then it was devascularized by means of surgical ligation of the ipsilateral superficial temporal artery (STA) and middle meningeal artery (MMA); these steps allowed a subsequent en block tumor excision, despite its large size, without significant blood loss and respecting the oncological principles. At the end, a contextual calvarial reconstruction was performed using a precurved titanium mesh. The patient was discharged seven days after surgery with complete recovery of the left-sided motor deficit. Thereafter, he underwent scheduled outpatient evaluations and radiological examinations. At 1-year follow-up, the Modified Rankin Scale (MRS) was 1, with no evidence of recurrent disease. To conclude, surgical complications can be reduced adopting an optimal preoperative work-up and a tailored surgical strategy focused on early tumor deafferentation. Moreover, an immediate cranial vault reconstruction avoids the risks related to a second procedure.
Asunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos de Cirugía Plástica , Mallas Quirúrgicas , Titanio , Humanos , Masculino , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Anciano , Procedimientos de Cirugía Plástica/métodos , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Hueso Parietal/cirugía , Hueso Parietal/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Imagen por Resonancia Magnética , Resultado del TratamientoRESUMEN
BACKGROUND Monostotic fibrous dysplasia is a benign proliferation of fibrous and osseous tissues that expand medullary bone to cause symptoms due to compression of adjacent organs and anatomical structures. Focal seizures are rarely the first sign of this kind of lesion. This report describes a young female patient with left-sided focal motor seizures associated with fibrous dysplasia presenting as a mass in the right parietal bone. CASE REPORT An 18-year-old female student with left-sided focal motor seizures presented with a mass in the right parietal bone. Computed tomography revealed an expansile mixed-density lesion on the right parietal bone, a relatively homogeneous ground-glass appearance in the outer circumferential portion, and a lucent eccentric area with thinned but sclerotic borders. Magnetic resonance imaging revealed a homogeneously hypointense signal on T1WI, a small hyperintense signal on T2WI, and avid enhancement signal intensity on post-contrast T1. Electroencephalogram showed inter-ictal epileptiform activities derived from the right fronto-central lobe. Surgical en bloc resection with a margin of normal bone and cranioplasty were performed. Histopathology showed features indicative of fibrous dysplasia, including osteoid trabeculae arranged haphazardly in a dense fibroblastic stroma, irregular trabeculae lacking conspicuous osteoblastic rimming, and intervening fibrous stroma containing cytologically bland spindle cells. The patient achieved seizure control and has remained neurologically intact. CONCLUSIONS This report has highlighted the importance of early diagnosis of fibrous dysplasia of bone to exclude primary bone malignancy or bone metastasis, to ensure rapid management and symptom control.
Asunto(s)
Hueso Parietal , Convulsiones , Humanos , Femenino , Adolescente , Convulsiones/etiología , Imagen por Resonancia Magnética , Displasia Fibrosa Monostótica/complicaciones , Displasia Fibrosa Monostótica/cirugía , Tomografía Computarizada por Rayos X , ElectroencefalografíaRESUMEN
OBJECTIVE: Topographic and blood vessel architecture study of the parietal area and distal regional pool of the superficial temporal artery (STA) to assess the possibility of revascularized cranium vault bone autograft formation. MATERIAL AND METHODS: For the topographic and anatomical study, 30 non-fixed corpses (17 male and 13 female) were selected, the average age of which was 59±5 years. In the anamnesis and catamnesis, there were no indications of trauma or other pathology of the head and neck, including vascular. STA was contrasted with a non-radiocontrast dye (brilliant green) with the introduction of the dye into the STA with preliminary ligation of the frontal branch of the STA. The area of blood supply to soft tissue and bone structures was studied. The angioarchitectonics of the parietal region was studied, the feeding vessel of the studied flap was identified. RESULTS: The obtained anatomical landmarks for the collection of CPFP flap make it possible to form a flap with high accuracy and minimize the morbidity of the donor area.
Asunto(s)
Arterias Temporales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Arterias Temporales/trasplante , Arterias Temporales/cirugía , Cráneo/cirugía , Cráneo/irrigación sanguínea , Autoinjertos/trasplante , Autoinjertos/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Trasplante Óseo/métodos , Hueso Parietal/cirugía , Hueso Parietal/irrigación sanguínea , Hueso Parietal/trasplanteRESUMEN
Gold standard method for the treatment of critical-sized bone defects is the autogenous bone grafting procedure. A number of new and potentially useful adjuncts currently are being investigated to enhance the success of bone grafting. We propose to evaluate the effect of the most known and easily obtained 2 biological materials, fat graft and platelet-rich plasma (PRP), on bone graft healing. Twenty-seven New Zealand male rabbits were included in this randomized, controlled study. Two-sided 15-mm diameter bone defects were created in the parietal bones and the bones taken were replaced right-to-left and vice versa with 1 control group, 1 fat graft applied group, and the last one PRP applied group. Histologic evaluation and 3-dimensional maxillofacial computerized tomography were performed and bone density was calculated. In radiologic analysis, bone density was significantly different in the PRP group compared with the control and fat graft group in the 12th week ( P <0.05). In histologic scoring analysis, the PRP group had a better score than the control and fat graft group, while the fat graft group was worse than the control group in the 6th week ( P <0.05). The addition of PRP had a positive effect whereas fat graft had a negative effect on bone graft healing compared with the control group.
Asunto(s)
Tejido Adiposo , Trasplante Óseo , Plasma Rico en Plaquetas , Distribución Aleatoria , Animales , Conejos , Trasplante Óseo/métodos , Masculino , Tejido Adiposo/trasplante , Densidad Ósea , Trasplante Autólogo , Cicatrización de Heridas/fisiología , Tomografía Computarizada por Rayos X , Hueso Parietal/cirugía , Imagenología Tridimensional , Modelos Animales de Enfermedad , Cráneo/cirugía , Cráneo/diagnóstico por imagenRESUMEN
A 77-year-old man presented with progressive consciousness disturbance, presumably caused by a backward fall. Head computed tomography findings showed a large intracerebral hemorrhage in the left parietal lobe. Radiated fractures with an oval depression of the bilateral parietal bone crossing the midline were noted. Surgical evacuation of the hemorrhage was performed via a left-sided parietal craniotomy, during which fragments from the fracture with eggshell-like thinning were noted. Biparietal thinning is an uncommon condition noted in radiological findings of a symmetrical oval depression of bilateral parietal bones with reduced diploe thickness. Cases of traumatic brain injury in patients with biparietal thinning have rarely been reported. This condition should be recognized as a possible predisposing factor for traumatic brain injury.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Hueso Parietal , Humanos , Masculino , Anciano , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/cirugía , Hueso Parietal/diagnóstico por imagen , Hueso Parietal/lesiones , Hueso Parietal/cirugía , Tomografía Computarizada por Rayos X , Lóbulo Parietal/diagnóstico por imagen , Craneotomía , Accidentes por CaídasRESUMEN
Foramina parietalia permagna (FPP) is a rare anatomical defect that affects the parietal bones of the human skull. FPP is characterized by symmetric perforations on either side of the skull, which are caused by insufficient ossification during embryogenesis. These openings are typically abnormally large and can range from a few millimeters to several centimeters in diameter. Enlarged foramina are often discovered incidentally during anatomical or radiological examinations and in most cases left untreated unless symptoms develop. Although this calvarial defect is usually asymptomatic, it may be accompanied by neurological or vascular conditions that can have clinical significance in certain cases. FPP is an inherited disorder and arises due to mutations in either Msh homeobox 2 (MSX2) or aristaless-like homeobox 4 (ALX4) genes. In almost all cases, one parent is affected. Clinical findings and diagnostic imaging typically contribute to determine the diagnosis.
Asunto(s)
Encefalocele , Haploinsuficiencia , Proteínas de Homeodominio , Humanos , Proteínas de Homeodominio/genética , Haploinsuficiencia/genética , Hueso Parietal/diagnóstico por imagen , Masculino , Femenino , Cráneo/diagnóstico por imagen , Cráneo/anomalías , Factores de Transcripción/genéticaRESUMEN
SUMMARY: Parietal emissary foramina (PEF) are small holes, which are localized between the middle and posterior thirds of the parietal bone posterior surface close to the sagittal suture. PEF are important structures that protect the parietal emissary vein, which passes through it. During neurosurgery procedures, parietal foramina (PF) knowledge is crucial. This work aimed to evaluate presence and location of the PF in the skull of an adult human. Moreover, measure the distance amidst PF and the sagittal suture's midline to ascertain its clinical repercussions. 74 adult human skulls, without gross pathology, were observed for the PF's existence. The PF's and sagittal suture's midline distance were measured. According to the PF patterns of presence, five groups were distributed. Finally, specimens were photographed and subjected to statistical analysis. The PF was absent in 7 skulls (9.5 %). There were 9 skulls (12.2 %) exhibited central parietal foramen where the parietal foramen lies on the sagittal suture. 17 skulls (23 %) showed right unilateral parietal foramen, whereas 15 skulls (20.3 %) demonstrated left unilateral parietal foramen. The final 26 skulls (35.1 %) exhibited bilateral parietal foramen. This descriptive study supplies valuable information of PF variations, which is crucial for neurosurgeons in modifying surgical techniques and procedures to alleviate injury to PF-emerging structures such as emissary veins.
Los forámenes emisarios parietales (FEP) son pequeños orificios que se localizan entre los tercios medio y posterior de la superficie posterior del hueso parietal, cerca de la sutura sagital. Los FEP son estructuras importantes que protegen la vena emisaria parietal, que lo atraviesa. Durante los procedimientos de neurocirugía, el conocimiento de los forámenes parietales (FP) es crucial. Este trabajo tuvo como objetivo evaluar la presencia y ubicación del FP en el cráneo de hombres adultos, además, medir la distancia entre el FP y la línea mediana de la sutura sagital para conocer su repercusión clínica. Se examinaron 74 cráneos humanos adultos, sin patología grave, para determinar la existencia del FP. Se midió la distancia de la línea mediana de la sutura sagital y del FP. De acuerdo con los patrones de presencia del FP, se distribuyeron en cinco grupos. Finalmente, los especímenes fueron fotografiados y sometidos a análisis estadístico. El PF estaba ausente en 7 cráneos (9,5 %). Hubo 9 cráneos (12,2 %) que presentaban un PF central localizándose en la sutura sagital. 17 cráneos (23 %) presentaban un FP unilateral derecho, mientras que 15 cráneos (20,3 %) se observó un FP unilateral izquierdo. Los 26 cráneos restantes (35,1 %) exhibieron FP bilaterales. Este estudio descriptivo proporciona información valiosa sobre las variaciones del FP, que es fundamental para los neurocirujanos en el momento de modificar las técnicas y los procedimientos quirúrgicos para aliviar las lesiones de las estructuras emergentes del FP, como las venas emisarias.
Asunto(s)
Humanos , Masculino , Adulto , Hueso Parietal/anatomía & histología , Suturas Craneales/anatomía & histología , Cráneo/anatomía & histologíaRESUMEN
Enlarged biparietal foramina is an autosomal dominant disorder that is caused by a failure of completion of ossification within the parietal bones. Enlarged parietal foramina measuring more than a few millimeters are uncommon. Even though spontaneous regression has been described, closure is rarely complete, and depending on the size of the resulting defect, an unprotected brain is a concern. There are few reports on the surgical management of persistent enlarged biparietal foramina. This is the first report describing our experience with a custom porous polyethylene implant.
Asunto(s)
Implantes Dentales , Polietileno , Humanos , Porosidad , Encefalocele , Hueso Parietal/diagnóstico por imagen , Hueso Parietal/cirugía , Hueso Parietal/anomalíasRESUMEN
SUMMARY: Parietal foramina of the human skull act as a passageway for emissary veins, connecting the superior sagittal sinus to the veins of the scalp. This passageway can lead to the spread of infection from the scalp to the dural venous sinuses, but may also assist in relieving intracranial pressure. However, variation in the prevalence of parietal foramina has been noted among population groups. This observational and descriptive study aimed to determine the incidence, size and location of parietal foramina by using osteological specimens of 252 African skulls from the Sefako Makgatho Health Sciences University, South Africa and 95 European skulls from the University of Leipzig, Germany. Parietal foramina were significantly more common in the African sample (61.9 %) compared to the European sample (55.8 %). Moreover, the Central European sample displayed more unilateral foramina (29.5 %), while the African sample exhibited more bilateral foramina (40.8 %). The diameter of the parietal foramen average 1.98 mm and 1.88 mm for the European and African samples, respectively. In this study, a median foramen on the sagittal suture was observed in 14 of the overall skull caps (4 %). This study demonstrated that parietal foramina are more prevalent than anticipated in both population groups. Findings of this study, indicating an increased prevalence, and the subsequent possibility of more emissary veins encountered, can be used to improve the understanding of the variations in the prevalence and clinical implications of the parietal foramen among various population groups located world-wide.
Los forámenes parietales del cráneo humano actúan como una vía para las venas emisarias, conectando el seno sagital superior con las venas del cuero cabelludo. Este pasaje puede conducir a la propagación de infecciones desde el epicráneo (calva) hasta los senos venosos durales, pero también puede ayudar a aliviar la presión intracraneal. Sin embargo, se ha observado una variación en la prevalencia de los forámenes parietales entre los grupos de población. Este estudio observacional y descriptivo tuvo como objetivo determinar la incidencia, el tamaño y la ubicación de los forámenes parietales mediante el uso de muestras osteológicas de 252 cráneos africanos de la Universidad de Ciencias de la Salud Sefako Makgatho, Sudáfrica, y 95 cráneos europeos de la Universidad de Leipzig, Alemania. Los forámenes parietales fueron significativamente más comunes en la muestra africana (61,9 %) en comparación con la muestra europea (55,8 %). Además, la muestra centroeuropea mostró más forámenes unilaterales (29,5 %), mientras que la muestra africana mostró más forámenes bilaterales (40,8 %). El diámetro del foramen parietal promedió 1,98 mm y 1,88 mm para las muestras europeas y africanas, respectivamente. En este estudio, se observó un foramen medio en la sutura sagital en 14 de los cráneos en general (4 %). El estudio demostró que los forámenes parietales son más frecuentes de lo previsto en ambos grupos de población. Los hallazgos de este estudio, que indican una mayor prevalencia y la subsiguiente posibilidad de que se encuentren más venas emisarias, pueden ser útiles para mejorar la comprensión de las variaciones en la prevalencia y las implicaciones clínicas del foramen parietal entre varios grupos de población ubicados en el mundo.
Asunto(s)
Humanos , Hueso Parietal/anatomía & histología , Presión Intracraneal , África , Europa (Continente)RESUMEN
AIM: To understand the characterization of the ossification process both in the synostotic suture, and the adjacent parietal bone. MATERIAL AND METHODS: The surgical procedure for the 28 patients diagnosed with sagittal synostosis consisted of removing the synostotic bone as a whole, if possible, "Barrel-Stave" relaxation osteotomies, and strip osteotomies to the parietal and temporal bones perpendicular to the synostotic suture. The synostotic (group I) and parietal (group II) bone segments are obtained during osteotomies. Atomic absorption spectrometry was used to determine the amount of calcium in both groups, which is an indicator of ossification. Scanning electron microscopy and immunohistochemistry were employed to assess trabecular bone formation, osteoblastic density, and osteopontin, which is one of the in vivo indicators of new bone formation. RESULTS: Histopathologically, trabecular bone formation scores did not indicate any significant difference between the groups. However, the osteoblastic density and calcium accumulation in group I were higher than those in group II, and the difference was significant. Osteopontin staining scores in cells showing membranous and cytoplasmic staining with osteopontin antibodies significantly increased in group II. CONCLUSION: In this study, we found reduced differentiation of osteoblasts despite their increase in number. Moreover, the osteoblastic maturation rate was low in synostotic sutures, bone resorption becomes slower than new bone formation, and the remodeling rate is low in sagittal synostosis.
Asunto(s)
Craneosinostosis , Osteopontina , Humanos , Niño , Lactante , Suturas Craneales/patología , Hueso Parietal/cirugía , Calcio , Craneosinostosis/cirugía , Craneosinostosis/patología , SuturasRESUMEN
BACKGROUND: Detailed morphometric data concentrating on the development of primary ossification centres in human fetuses is critical for the early detection of developmental defects. Thus, an understanding of the growth and development of the parietal bone is crucial in assessing both the normal and pathological development of the calvaria. MATERIALS AND METHODS: The size of the parietal primary ossification centre in 37 spontaneously aborted human fetuses of both sexes (16 males and 21 females) aged 18-30 weeks was studied by means of computed tomography, digital-image analysis and statistics. RESULTS: The numerical data of the parietal primary ossification centre in the human fetus displays neither sex nor laterality differences. With relation to fetal age in weeks, the parietal primary ossification centre grew in sagittal diameter according to the quadratic function: y = 16.322 + 0.0347 × (age)² ± 1.323 (R² = 0.96), in projection surface area according to the cubic function: y = 284.1895 + 0.051 × × (age)³ ± 0.490, while in both coronal diameter and volume according to the quartic functions: y = 21.746 + 0.000025 × (age)4 ± 1.256 and y = 296.984 + + 0.001 × (age)4, respectively. CONCLUSIONS: The obtained morphometric data of the parietal primary ossification centre may be considered age-specific references, and so may contribute to the estimation of gestational ages and be useful in the diagnostics of congenital cranial defects.
Asunto(s)
Desarrollo Fetal , Hueso Parietal , Masculino , Femenino , Humanos , Hueso Parietal/diagnóstico por imagen , Osteogénesis , Feto/diagnóstico por imagen , Edad GestacionalRESUMEN
Intracranial epidermoid cyst is a rare pseudotumor of the nervous system, accounting for 0.2%-1.8% of all intracranial tumors. It is usually located in the cerebellopontine Angle or parasellar area, with insipid onset, slow growth and usually less than 2 cm in diameter. Giant epidermoid cysts that invade the bone have rarely been reported in the literature. Herein, we report a case of giant ECs extradural to the parietal bone, penetrating the skull and continuing to expand outward. In addition, a systematic search of four authoritative databases was conducted to collect the relevant reports of giant epidermoid cyst with diameter > 5cm for the first time, and to discuss the clinical and radiographic features of patients with giant epidermoid cyst and the influence of treatment options.
Asunto(s)
Neoplasias Encefálicas , Quiste Epidérmico , Humanos , Quiste Epidérmico/diagnóstico por imagen , Quiste Epidérmico/cirugía , Quiste Epidérmico/patología , Cráneo/diagnóstico por imagen , Cráneo/cirugía , Cabeza , Hueso Parietal/diagnóstico por imagen , Hueso Parietal/cirugía , Hueso Parietal/patologíaRESUMEN
Idiopathic focal unilateral skull thinning is a rare finding. An explanation, such as trauma or disease, can often be found. However, in some cases, no explanation is forthcoming, and thus, we must look further into their history for a possible cause. The case of a nine-year-old boy with a crescent-shaped unilateral parietal bone thinning and a history of ventouse-assisted birth is presented. The lesion matches a ventouse's typical location, shape, and size. Thus, with the support of one other reported similar case, we hypothesise this may be the origin. We present the case of a crescent-shaped lesion matching the imprint of a ventouse in a child with a concordant history. This finding is put in the context of similar reports in the literature, and we believe that this report provides further evidence of this obscure phenomenon. Funding: None declared.
Asunto(s)
Hueso Parietal , Humanos , Masculino , Hueso Parietal/diagnóstico por imagen , Niño , Diagnóstico Diferencial , Tomografía Computarizada por Rayos XRESUMEN
Anatomical or morphological variations of the skull bones usually do not attract much attention among forensic pathologists. However, these variations can sometimes be an important marker in forensic identification of a person or represent a missing piece when solving a cranial trauma puzzle. In this article, we were interested in peculiar presentation of the thinning of both parietal bones (biparietal osteodystrophy). The course and etiology of this condition still remain unknown. In three autopsy cases with biparietal osteodystrophy (three females aged 95, 90 and 83) and no head trauma, we used conventional (CT) and microcomputed tomography (micro-CT) imaging of the skull and parietal bone specimens containing normal bone, transitional zone and thinned bone with osteodystrophy. CT images demonstrated an oval-shaped resorptive parietal bone depression with smooth contours, without marginal osteosclerotic changes or involvement of cranial sutures. In the transitional zone, micro-CT scans showed a decrease in total bone thickness and the thickness of diplöe, while inner and outer tables showed increased porosity. At the site of maximal thinness of the parietal bone, inner and outer tables fused and formed a thin layer of cortical bone. Skull thinning appeared due to the reduced thickness of diplöe, leading to egg-shell thinning in the central area of the parietal bones. A forensic pathologist should be familiar with this benign condition in order not to confuse it with resorptive bone diseases.
Asunto(s)
Hueso Parietal , Cráneo , Autopsia , Suturas Craneales , Femenino , Humanos , Hueso Parietal/diagnóstico por imagen , Microtomografía por Rayos XRESUMEN
OBJECTIVE: Variables that can predict outcomes in patients with craniosynostosis, including bone thickness, are important for surgical decision-making, yet are incompletely understood. Recent studies have demonstrated relative risks and benefits of surgical techniques for correcting head shape in patients with nonsyndromic sagittal craniosynostosis. The purpose of this study was to characterize the relationships between parietal bone thickness and perioperative outcomes in patients who underwent spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis. METHODS: Patients who underwent craniectomy and SMC for nonsyndromic sagittal craniosynostosis at a quaternary pediatric hospital between 2011 and 2021 were included. Parietal bone thickness was determined on patient preoperative CT at 27 suture-related points: at the suture line and at 0.5 cm, 1.0 cm, 1.5 cm, and 2.0 cm from the suture at the anterior parietal, midparietal, and posterior parietal bones. Preoperative skull thickness was compared with intraoperative blood loss, need for intraoperative transfusion, and hospital length of stay (LOS). RESULTS: Overall, 124 patients with a mean age at surgery ± SD of 3.59 ± 0.87 months and mean parietal bone thickness of 1.83 ± 0.38 mm were included in this study. Estimated blood loss (EBL) and EBL per kilogram were associated with parietal bone thickness 0.5 cm (ρ = 0.376, p < 0.001 and ρ = 0.331, p = 0.004; respectively) and 1.0 cm (ρ = 0.324, p = 0.007 and ρ = 0.245, p = 0.033; respectively) from the suture line. Patients with a thicker parietal bone 0.5 cm (OR 18.08, p = 0.007), 1.0 cm (OR 7.16, p = 0.031), and 1.5 cm (OR 7.24, p = 0.046) from the suture line were significantly more likely to have undergone transfusion when controlling for age, sex, and race. Additionally, parietal bone thickness was associated with hospital LOS (ß 0.575, p = 0.019) when controlling for age, sex, and race. Patient age at the time of surgery was not independently associated with these perioperative outcomes. CONCLUSIONS: Parietal bone thickness, but not age at the time of surgery, may predict perioperative outcomes including transfusion, EBL, and LOS. The need for transfusion and EBL were most significant for parietal bone thickness 0.5 cm to 1.5 cm from the suture line, within the anticipated area of suturectomy. For patients undergoing craniofacial surgery, parietal bone thickness may have important implications for anticipating the need for intraoperative transfusion and hospital LOS.
Asunto(s)
Craneosinostosis , Hueso Parietal , Pérdida de Sangre Quirúrgica , Niño , Craneosinostosis/diagnóstico por imagen , Craneosinostosis/cirugía , Craneotomía/métodos , Humanos , Lactante , Hueso Parietal/diagnóstico por imagen , Hueso Parietal/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Cráneo/diagnóstico por imagen , Cráneo/cirugía , Resultado del TratamientoRESUMEN
A system-by-system approach dominates morphological and evolutionary study; however, some structures that are better understood within the context of an interface between two systems or traditional units remain less well understood. As part of a larger goal to clarify aspects of skull-neck boundary evolution, we herein describe the morphology and development of the occiput and atlas-axis complex in the crocodylian Alligator mississippiensis. We apply micro-computed tomography scanning, clearing and double staining, and histological analyses to skull-neck boundary structures at three stages of development (embryonic stage 22, 23, and hatchling). Regions of ossification that could possibly pertain to a postparietal were found adjacent to the parietal bone and supraoccipital; however, these were not deemed convincing and are considered part of the supraoccipital. Within the atlas-axis complex, the proatlas appears as two discrete cartilaginous elements in Stage 22 that ossify together at Stage 23. Posterior to the proatlas, the atlas-axis complex is composed of two centra, each with cervical ribs ventrally and neural arches dorsally that begin ossifying at Stage 23. Histology and clearing and staining of Stages 22 and 23 embryos reveal a discrete atlas intercentrum applied to the ventral part of the occipital condyle of the skull. Posterior to this is a cartilage that appears to be a co-chondrified atlas pleurocentrum, axis intercentrum, and axis pleurocentrum. Ossification of this cartilaginous structure produces discrete atlas inter- and pleurocentra, as well as a singular axis centrum. Together these data are discussed with reference to clarifying historical discrepancies concerning elements at the crocodylian skull-neck boundary.
Asunto(s)
Caimanes y Cocodrilos , Caimanes y Cocodrilos/anatomía & histología , Animales , Cabeza , Hueso Parietal/anatomía & histología , Cráneo/anatomía & histología , Microtomografía por Rayos XRESUMEN
Limited information is available on the effect of sagittal craniosynostosis (CS) on morphological and material properties of the parietal bone. Understanding these properties would not only provide an insight into bone response to surgical procedures but also improve the accuracy of computational models simulating these surgeries. The aim of the present study was to characterise the mechanical and microstructural properties of the cortical table and diploe in parietal bone of patients affected by sagittal CS. Twelve samples were collected from pediatric patients (11 males, and 1 female; age 5.2 ± 1.3 months) surgically treated for sagittal CS. Samples were imaged using micro-computed tomography (micro-CT); and mechanical properties were extracted by means of micro-CT based finite element modelling (micro-FE) of three-point bending test, calibrated using sample-specific experimental data. Reference point indentation (RPI) was used to validate the micro-FE output. Bone samples were classified based on their macrostructure as unilaminar or trilaminar (sandwich) structure. The elastic moduli obtained using RPI and micro-FE approaches for cortical tables (ERPI 3973.33 ± 268.45 MPa and Emicro-FE 3438.11 ± 387.38 MPa) in the sandwich structure and diploe (ERPI1958.17 ± 563.79 MPa and Emicro-FE 1960.66 ± 492.44 MPa) in unilaminar samples were in strong agreement (r = 0.86, p < .01). We found that the elastic modulus of cortical tables and diploe were correlated with bone mineral density. Changes in the microstructure and mechanical properties of bone specimens were found to be irrespective of patients' age. Although younger patients are reported to benefit more from surgical intervention as skull is more malleable, understanding the material properties is critical to better predict the surgical outcome in patients <1 year old since age-related changes were minimal.
Asunto(s)
Craneosinostosis , Hueso Parietal , Niño , Craneosinostosis/diagnóstico por imagen , Femenino , Humanos , Lactante , Hueso Parietal/diagnóstico por imagen , Microtomografía por Rayos XRESUMEN
In adult humans, the orbits vary mostly in their orientation in relation to the frontal bone profile, while the orientation of the cranial base and face are associated with the anteroposterior dimensions of the parietal bone. Here we investigate the effect of parietal bone length on the orientation of the orbits, addressing craniofacial integration and head orientation. We applied shape analysis to a sample of computed tomography scans from 30 adult modern humans, capturing the outlines of the parietal and frontal bones, the orbits, and the lateral and midline cranial base, to investigate shape variation, covariation, and modularity. Results show that the orientation of the orbits varies in accordance with the anterior cranial base, and in association with changes in parietal bone longitudinal extension. Flatter, elongated parietal bones are associated with downwardly oriented orbits and cranial bases. Modularity analysis points to a significant integration among the orbits, anterior cranial base, and the frontal profile. While the orbits are morphologically integrated with the adjacent structures in terms of shape, the association with parietal bone size depends on the spatial relationship between the two blocks. Complementary changes in orbit and parietal bone might play a role in accommodating craniofacial variability and may contribute to maintain the functional axis of the head. To better understand how skull morphology and head posture relate, future studies should account for the spatial relationship between the head and the neck.