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1.
Georgian Med News ; (306): 151-155, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-33130664

RESUMO

The aim of the research was to the study morphological features of the maxilla in people of different ages according to the results of craniometric researches. A craniometric study was performed on 50 bone preparations of the skull with the calculation of the main indices of the skull, including cranial, facial, high-longitudinal, high-latitude, transverse-zygomatic and frontal-zygomatic indices, as well as the main linear parameters of the maxilla - length, width and height. In the studied material, three main morphological types of the structure of the skull are presented: brachycrania (people with round head), mesocrania (people with middle head) and dolichocrania (people with long head). More often than others there was a brachycranial form, in which a decrease in the height-longitudinal parameters of the skull was observed, at the same time in dolichocracy there was an increase in the height-longitudinal and height-latitude parameters, in mesocracy - their intermediate indicators. The variability of the skull indices determines the variability of the main parameters of the maxilla. In people with a brachymorphic skull, a wider type of the facial section and, accordingly, of the maxilla is observed, in skulls with a meso- and dolichomorphic form of structure, on the contrary, the middle and narrow type of the maxilla is more common.


Assuntos
Maxila , Crânio , Cefalometria , Humanos , Maxila/diagnóstico por imagem , Crânio/diagnóstico por imagem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33027392

RESUMO

Tuberculosis of the skull or calvarial tuberculosis (CTB) is rare. The literature until 2019 reported less than 60 cases of CTB in childhood. The authors describe two patients with CTB associated with other manifestations of TB, such as: spine and rib injuries, peripheral adenopathy, hepatic and splenic involvement who improved with chemotherapy. The patients were a four-year-old and an eight-year-old child, whose diagnoses were confirmed by histopathological, bacteriological or molecular investigation. Both were not infected with the human immunodeficiency virus (HIV) and did not need orthopedic treatment.


Assuntos
Crânio/diagnóstico por imagem , Teste Tuberculínico/métodos , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Humanos , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose/tratamento farmacológico
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1440-1443, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018261

RESUMO

Electrical Impedance Tomography (EIT) can be used to estimate the electrical properties of the head tissues in a parametric approach. This modality is called parametric EIT or bounded EIT (bEIT). Typical bEIT protocols alternate between several current injection patterns with two current injection electrodes each: one source and one sink ("1-to-1"), while the rest of the electrodes measure the resulting electric potential. Then, one value of conductivity per tissue (e.g. scalp and/or skull) is estimated independently for each current injection pair. With these protocols, it is difficult to obtain local estimates of the skull tissue. Thus, the grand average of the estimates obtained from each pair is assigned to each tissue modeling them as homogeneous. However, it is known that these tissues are inhomogeneous within the same subject. We propose the use of current injection patterns with one source and many sinks ("1to-N") located at the opposite side of the head to build individual and inhomogeneous skull conductivity maps. We validate the method with simulations and compare its performance with equivalent maps generated by using the classical "1-to-1" patterns. The map generated by the novel method shows better spatial correlation with the more conductive spongy bone presence.Clinical Relevance- The novel bEIT protocol allows to map individual head models with spatially resolved skull conductivities in vivo and non-invasively for use in electroencephalography (EEG) source localization, transcranial electrical stimulation (TES) dose calculations and TES pattern optimization, without the risk of ionizing radiation associated with computed tomography (CT) scans.


Assuntos
Crânio , Tomografia Computadorizada por Raios X , Condutividade Elétrica , Eletroencefalografia , Couro Cabeludo , Crânio/diagnóstico por imagem
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32868470

RESUMO

Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shape changes, as well as secondary craniofacial characteristics, that occur in the setting of the various primary craniosynostoses and deformations. As an introduction, the physiology and genetics of skull growth as well as the pathophysiology underlying craniosynostosis are reviewed. This is followed by a description of each type of primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, and frontosphenoidal) and their resultant head shape changes, with an emphasis on differentiating conditions that require surgical correction from those (bathrocephaly, deformational plagiocephaly/brachycephaly, and neonatal intensive care unit-associated skill deformation, known as NICUcephaly) that do not. The report ends with a brief discussion of microcephaly as it relates to craniosynostosis as well as fontanelle closure. The intent is to improve pediatric care providers' recognition and timely referral for craniosynostosis and their differentiation of synostotic from deformational and other nonoperative head shape changes.


Assuntos
Craniossinostoses/diagnóstico , Acrocefalossindactilia/genética , Fenótipo de Síndrome de Antley-Bixler/genética , Suturas Cranianas/anatomia & histologia , Disostose Craniofacial , Craniossinostoses/classificação , Craniossinostoses/etiologia , Craniossinostoses/cirurgia , Cabeça/anormalidades , Humanos , Lactente , Hipertensão Intracraniana/etiologia , Ilustração Médica , Microcefalia/etiologia , Osteogênese/fisiologia , Fenótipo , Fotografação , Polidactilia/genética , Receptores de Fatores de Crescimento de Fibroblastos/metabolismo , Procedimentos Cirúrgicos Reconstrutivos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Crânio/crescimento & desenvolvimento , Sinostose/complicações , Sinostose/diagnóstico por imagem
6.
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740631
7.
Arch Gynecol Obstet ; 302(3): 619-628, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32556516

RESUMO

INTRODUCTION: Neural tube defects (NTDs) are a group of heterogeneous congenital anomalies of the central nervous system (CNS). Acrania is a non-NTD congenital disorder related to the CNS. It can transform into anencephaly through the acrania-exencephaly-anencephaly sequence (AEAS). In AEAS, the cerebral tissue is not protected and is gradually destroyed due to exposure to the harmful effect of amniotic fluid and mechanical injuries. These lead to exencephaly and then into anencephaly. In contrast to primary anencephaly (NTDs), this type of anencephaly authors suggests calling secondary anencephaly. OBJECTIVE: Analysis of the known prenatal ultrasonography (US) signs associated with AEAS. Simultaneously, the authors propose a new sign in the differentiation of acrania from exencephaly and anencephaly, called the "beret" sign. METHODS: It is a two-centre retrospective observational study. As part of the study, 4060 US scans were analyzed. RESULTS: In 10 cases, the absence of calvarium was diagnosed, allowing recognition of either AEAS stages or primary anencephaly. In 5 cases, cerebral structures were enclosed by an inertial rippled thin membrane, with a smooth outer contour. Between the described membrane and the brain structures, a thin anechoic space corresponding to cerebrospinal fluid was observed. This sign was defined as the "beret" sign. In these cases, acrania was diagnosed. In three cases calvarium was missing. The brain structures had an irregular appearance, did not wave and remained motionless. The outer contour was unequal as if divided into lobes. Amniotic fluid was anechoic. Exencephaly was diagnosed in these cases. In two cases calvarium, brain structures, and meninges were missing. The "frog eyes" sign and slightly echogenic amniotic fluid were visible. In this case, anencephaly was diagnosed. CONCLUSIONS: The "beret" sign seems to be a promising tool in the diagnosis of acrania. Furthermore, echogenicity of amniotic fluid could be useful during differentiation between primary and secondary anencephaly.


Assuntos
Anencefalia/diagnóstico por imagem , Defeitos do Tubo Neural/diagnóstico por imagem , Crânio , Ultrassonografia Pré-Natal/métodos , Líquido Amniótico , Anencefalia/complicações , Anencefalia/diagnóstico , Biomarcadores , Encéfalo/anormalidades , Feminino , Humanos , Recém-Nascido , Defeitos do Tubo Neural/complicações , Gravidez , Estudos Retrospectivos , Crânio/anormalidades , Crânio/diagnóstico por imagem , Ultrassonografia
8.
J Vis Exp ; (159)2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32510490

RESUMO

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused deposition modeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.


Assuntos
Desenho Assistido por Computador , Face/cirurgia , Impressão Tridimensional , Próteses e Implantes , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Osteotomia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Tomografia Computadorizada por Raios X
9.
J Craniofac Surg ; 31(4): 1015-1017, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503096

RESUMO

Three-dimensional (3D) imaging of the craniofacial skeleton is integral in managing a wide range of bony pathologies. The authors have previously demonstrated the potential of "Black Bone" MRI (BB) as a non-ionizing alternative to CT. However, even in experienced hands 3D rendering of BB datasets can be challenging and time consuming. The objectives of this study were to develop and test a semi- and fully-automated segmentation algorithm for the craniofacial skeleton.Previously acquired adult volunteer (n = 15) BB datasets of the head were utilized. Imaging was initially 3D rendered with our conventional manual technique. An algorithm to remove the outer soft-tissue envelope was developed and 3D rendering completed with the processed datasets (semi-automated). Finally, a fully automated 3D-rendering method was developed and applied to the datasets. All 3D rendering was completed with Fovia High Definition Volume Rendering (Fovia Inc, Palo Alto, CA). Analysis was undertaken of the 3D visual results and the time taken for data processing and interactive manipulation.The mean time for manual segmentation was 12.8 minutes, 3.1 minutes for the semi-automated algorithm, and 0 minutes for the fully automated algorithm. Further fine adjustment was undertaken to enhance the automated segmentation results, taking a mean time of 1.4 minutes.Automated segmentation demonstrates considerable potential, offering significant time saving in the production of 3D BB imaging in adult volunteers. the authors continue to undertake further development of our segmentation algorithms to permit adaption to the pediatric population in whom non-ionizing imaging confers the most potential benefit.


Assuntos
Imagem por Ressonância Magnética , Crânio/diagnóstico por imagem , Adulto , Algoritmos , Humanos , Imageamento Tridimensional , Reprodutibilidade dos Testes
10.
PLoS One ; 15(4): e0232631, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353054

RESUMO

BACKGROUND AND PURPOSE: Posttraumatic hydrocephalus affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) after traumatic brain injury and necessitates a ventriculo-peritoneal shunt placement. As bone and arachnoid trabeculae share the same collagen type, we investigated possible connections between the skull Hounsfield unit (HU) values and shunt-dependent hydrocephalus (SDHC) in patients that received cranioplasty after DC for traumatic acute subdural hematoma (SDH). METHODS: We measured HU values in the frontal bone and internal occipital protuberance from admission brain CT. Receiver operating characteristic curve analysis was performed to identify the optimal cut-off skull HU values for predicting SDHC in patients receiving cranioplasty after DC due to traumatic acute SDH. We investigated independent predictive factors for SDHC occurrence using multivariable logistic regression analysis. RESULTS: A total of 162 patients (>15 years of age) were enrolled in the study over an 11-year period from two university hospitals. Multivariable logistic analysis revealed that the group with simultaneous frontal skull HU ≤797.4 and internal occipital protuberance HU ≤586.5 (odds ratio, 8.57; 95% CI, 3.05 to 24.10; P<0.001) was the only independent predictive factor for SDHC in patients who received cranioplasty after DC for traumatic acute SDH. CONCLUSIONS: Our study reveals a potential relationship between possible low bone mineral density and development of SDHC in traumatic acute SDH patients who had undergone DC. Our findings provide deeper insight into the association between low bone mineral density and hydrocephalus after DC for traumatic acute SDH.


Assuntos
Craniectomia Descompressiva/efeitos adversos , Hematoma Subdural Agudo/cirurgia , Hidrocefalia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Crânio/diagnóstico por imagem , Adulto , Idoso , Feminino , Seguimentos , Hematoma Subdural Agudo/diagnóstico por imagem , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco/métodos , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/estatística & dados numéricos
11.
Plast Reconstr Surg ; 146(3): 314e-323e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32459727

RESUMO

BACKGROUND: Current methods to analyze three-dimensional photography do not quantify intracranial volume, an important metric of development. This study presents the first noninvasive, radiation-free, accurate, and reproducible method to quantify intracranial volume from three-dimensional photography. METHODS: In this retrospective study, cranial bones and head skin were automatically segmented from computed tomographic images of 575 subjects without cranial abnormality (average age, 5 ± 5 years; range, 0 to 16 years). The intracranial volume and the head volume were measured at the cranial vault region, and their relation was modeled by polynomial regression, also accounting for age and sex. Then, the regression model was used to estimate the intracranial volume of 30 independent pediatric patients from their head volume measured using three-dimensional photography. Evaluation was performed by comparing the estimated intracranial volume with the true intracranial volume of these patients computed from paired computed tomographic images; two growth models were used to compensate for the time gap between computed tomographic and three-dimensional photography. RESULTS: The regression model estimated the intracranial volume of the normative population from the head volume calculated from computed tomographic images with an average error of 3.81 ± 3.15 percent (p = 0.93) and a correlation (R) of 0.96. The authors obtained an average error of 4.07 ± 3.01 percent (p = 0.57) in estimating the intracranial volume of the patients from three-dimensional photography using the regression model. CONCLUSION: Three-dimensional photography with image analysis provides measurement of intracranial volume with clinically acceptable accuracy, thus offering a noninvasive, precise, and reproducible method to evaluate normal and abnormal brain development in young children. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, V.


Assuntos
Imageamento Tridimensional , Fotografação/métodos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tamanho do Órgão , Estudos Retrospectivos
12.
J Craniofac Surg ; 31(5): e445-e448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32371683

RESUMO

Hemangiomas are benign vascular lesions characterized by endothelial vascular proliferation and may demonstrate aggressive clinical features. Intraosseous hemangiomas are uncommon and the maxillary location rare, with few cases described in the literature. The treatment of these lesions varies, however they have a better prognosis when a surgical treatment through resection is performed. The aim of this study is to report a case of right maxillary cavernous intraosseous hemangioma treated by surgical resection with previous embolization. The diagnosis was made through incisional biopsy and immunohistochemical examination. An aggressive lesion profile was observed through the Ki67 marker. During surgery, a temporary ipsilateral external carotid artery ligation was performed to minimize possible bleeding. Weber-Fergson surgical access was performed and total surgical resection through hemi-maxillectomy. The patient is stable after 30 months of follow-up without relapses. In suspected cases of intraosseous hemangiomas, accurate diagnosis and total surgical resection of the lesion is essential. The use of therapeutic mammoths that minimize sagging during and after the procedure such as embolization and arteriography should always be performed.


Assuntos
Hemangioma Cavernoso/cirurgia , Neoplasias Maxilares/cirurgia , Crânio/anormalidades , Coluna Vertebral/anormalidades , Malformações Vasculares/cirurgia , Craniotomia , Embolização Terapêutica , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Masculino , Neoplasias Maxilares/diagnóstico por imagem , Crânio/diagnóstico por imagem , Crânio/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Malformações Vasculares/diagnóstico por imagem , Adulto Jovem
13.
Medicine (Baltimore) ; 99(16): e19786, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311988

RESUMO

The posterior fossa is an important brain structure containing the cerebellum, cerebral ventricle, and cistern. Early evaluation of the cerebellar structure and function may be valuable for early detection of fetal deformities. At present, no normal value for the fetal posterior fossa has been established yet. This study is aimed to investigate the development of the posterior fossa in normal Chinese fetuses by using magnetic resonance imaging (MRI).Pregnant women who need MRI scan were enrolled in our Hospital between January 2012 and December 2014. The fetal supero-inferior diameter (SID), anterio-posterior diameter (APD), cerebellar vermis area, cerebellar width (CW), cerebellar volume (CV), superior cerebellar cistern width, and cerebellomedullary cistern width were measured using MRI. Pearson's correlation analysis was used to detect the relationship between those parameters and gestational age. A regression analysis was performed for all parameters.A total of 92 participants were retrospectively enrolled finally. The results indicated SID, APD, cerebellar vermis area, CW, and CV were positively associated with gestational age, while no significant correlation was found between the superior cerebellar cistern width and cerebellomedullary cistern width and gestational age. Each equation was established.Our study demonstrated that MRI has the advantages over ultrasound imaging for prenatal evaluation of the fetal posterior fossa with multiple views. Normal value of the posterior fossa of Chinese fetuses was established in this study.


Assuntos
Cerebelo/diagnóstico por imagem , Feto/diagnóstico por imagem , Crânio/embriologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Gravidez , Valores de Referência , Estudos Retrospectivos , Crânio/diagnóstico por imagem
15.
Plast Reconstr Surg ; 145(5): 953e-962e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332544

RESUMO

BACKGROUND: Currently, the pathogenesis of leptomeningeal cysts, also known as growing skull fractures, is still debated. The purpose of this study was to examine the specific skull fracture characteristics that are associated with the development of growing skull fractures and describe the authors' institutional experience managing this rare entity. METHODS: A retrospective cohort study was performed that included all patients younger than 5 years presenting to a single institution with skull fractures from 2003 to 2017. Patient demographics, cause of injury, skull fracture characteristics (e.g., amount of diastasis, linear versus comminuted fracture), concomitant neurologic injuries, and management outcomes were recorded. Potential factors contributing to the development of a growing skull fracture and neurologic injuries associated with growing skull fractures were evaluated using univariate logistic regression. RESULTS: A total of 905 patients met the authors' inclusion criteria. Of these, six (0.66 percent) were diagnosed with a growing skull fracture. Growing skull fractures were more likely to be comminuted (83.3 percent versus 40.7 percent; p = 0.082) and to present with diastasis on imaging (100 percent versus 26.1 percent; p < 0.001; mean amount of diastasis, 7.1 mm versus 3.1 mm; p < 0.001). Univariate logistic regression analysis confirmed the role of a comminuted fracture pattern (OR, 7.572) and the degree of diastasis (OR, 2.081 per mm diastasis) as significant risk factors for the development of growing skull fractures. CONCLUSIONS: The authors' analysis revealed that fracture comminution and diastasis width are associated with the development of growing skull fractures. The authors recommend dural integrity assessment, close follow-up, and early management in young children who present with these skull fracture characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Cistos Aracnóideos/epidemiologia , Fraturas Cranianas/complicações , Cistos Aracnóideos/etiologia , Cistos Aracnóideos/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Crânio/diagnóstico por imagem , Crânio/lesões , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X
16.
Plast Reconstr Surg ; 145(5): 1241-1248, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332546

RESUMO

BACKGROUND: Reports of neurodevelopmental delays in adolescents with metopic craniosynostosis have ranged from 15 to 61 percent. Previously, event-related potentials have correlated preoperative radiographic severity with language deficiencies in infancy. This study sought to characterize neurocognitive testing at cranial maturity and correlate outcomes to preoperative radiographic severity. METHODS: Patients diagnosed with metopic craniosynostosis who underwent surgical correction in infancy completed a neurodevelopmental battery evaluating age-normalized intelligence quotient, academic achievement, and visuomotor integration. Data were stratified by preoperative endocranial bifrontal angle (moderate, >124 degrees; severe, <124 degrees). Multiple variable regression was used to control measured intelligence and achievement for age at surgery, age at testing, parental education, and income. Significance was set at p < 0.05. RESULTS: Twenty patients completed neurodevelopmental testing. Mean intelligence quotient was 111.7 ± 13 and academic achievement was similar to national averages (word reading, 53.4 percent; reading comprehension, 53.4 percent; reading composite, 53.5 percent; spelling, 44 percent; and math, 52.9 percent). Radiographic measurements revealed 36 percent of patients with moderate phenotype and 64 percent with severe. Patients with severe phenotypes had lower intelligence quotient measures and scored more poorly in every academic measure tested. Word reading (113 versus 95; p = 0.035) and reading composite (109 versus 98; p = 0.014) reached significance. CONCLUSIONS: Overall, cranial mature patients with metopic craniosynostosis had above average intelligence quotient and academic achievement near the national mean. Long-term neurocognitive function was correlated to preoperative radiographic severity in metopic craniosynostosis, with more severe cases performing worse. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Sucesso Acadêmico , Craniossinostoses/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Crânio/diagnóstico por imagem , Adolescente , Criança , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/prevenção & controle , Feminino , Humanos , Lactente , Testes de Inteligência , Masculino , Período Pré-Operatório , Radiografia , Índice de Gravidade de Doença , Resultado do Tratamento
18.
World Neurosurg ; 139: 70-74, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298820

RESUMO

BACKGROUND: Chiari 1 malformation is a structural abnormality of the hindbrain and posterior fossa characterized by herniation of the cerebellar tonsils through the foramen magnum. Although asymptomatic in some cases, hindbrain herniation can be associated with disruption of cerebrospinal fluid flow dynamics at the craniovertebral junction and syrinx formation, leading to symptoms. Foramen magnum decompression with or without duraplasty has been the most commonly performed surgical procedure in the management of this condition. The management of syringomyelia associated with Chiari malformation is more challenging and controversial. Although the associated syrinx can significantly improve after craniovertebral decompression and restoration of cerebrospinal fluid flow, in some cases, it will persist despite decompressive surgery and could even continue to enlarge. CASE DESCRIPTION: We have described the case of a 4-year-old boy with non-craniosynostotic Chiari malformation and extensive cervical syrinx who, despite foramen magnum decompression and further revision, continued to deteriorate clinically and radiologically. Posterior calvarial augmentation was performed as a salvage procedure, with resolution of the tonsillar herniation and syrinx. CONCLUSIONS: Posterior calvarial augmentation is a viable option for patients with Chiari malformation refractory to foramen magnum decompression.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Forame Magno/cirurgia , Osso Occipital/cirurgia , Osso Parietal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Siringomielia/cirurgia , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Cerebelo/cirurgia , Vértebras Cervicais , Pré-Escolar , Descompressão Cirúrgica , Progressão da Doença , Forame Magno/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Laminectomia , Masculino , Osso Occipital/diagnóstico por imagem , Osso Parietal/diagnóstico por imagem , Escoliose/etiologia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Vértebras Torácicas , Tomografia Computadorizada por Raios X
19.
Cient. dent. (Ed. impr.) ; 17(1): 57-63, ene.-abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-189750

RESUMO

El objetivo de este trabajo es realizar una revisión bibliográfica para evaluar la posible relación entre los patrones de crecimiento facial con la maduración dental y esquelética en pacientes en crecimiento. La maduración dental y esquelética son dos indicadores que nos permiten es-tablecer en qué momento del desarrollo se encuentra el paciente en crecimiento. Actualmente, para la valoración de la maduración esquelética se emplea la visualización de las vértebras cervicales en la radiografía lateral de cráneo, ya que es un método que permite disminuir la exposición radiológica del paciente que se encuentra en estudio ortodóncico, en comparación con la radiografía de muñe-ca, la cual suponía la realización de una radiografía adicional. Para el análisis de la maduración dental, la radiografía panorámica es la más empleada mediante la visualización del desarrollo de los siete dientes mandibulares izquierdos. Los pacientes que se encuentran en edad infantil presentan diversos patrones de crecimiento facial, entre los que podemos encontrar, braquifacial, mesofacial y dolicofacial. Para poder establecer el patrón de crecimiento que presenta el paciente existen diversos métodos que, a través de mediciones cefalométricas, nos clasifican al paciente en uno de los tres grupos. Existen diversos trabajos que estudian la posible relación entre los patrones de crecimiento facial y la maduración dental y esquelética. Según la literatura revisada podemos concluir que los pacientes que presentan un patrón de crecimiento vertical muestran una maduración dental y esquelética más avanzada en comparación con los pacientes que presentan un patrón de crecimiento horizontal


The objective of this paper is to present a bibliographical review to evaluate the possible relationship between facial growth patterns and dental and skeletal maturation in growing patients.Dental and skeletal maturation are two indicators that allow us to establish at what point the patient is in his growth. Currently, for the evaluation of skeletal maturation, the visualisation of the cervical vertebrae in the lateral x-ray of the skull is used, since this is a method that diminishes the radiological exposure of the patient undergoing an orthodontic study, in comparison with the x-ray of the wrist, which means taking an additional x-ray.For the analysis of dental maturation, the panoramic x-ray is the most used through visualisation of the development of the seven left jaw teeth. Children in young ages present different facial growth patterns, among which we can find brachyfacial, mesofacial and dolichofacial. In order to establish the growth pattern the patient presents, there are different methods that, through cephalometric measurements, classify the patient in one of the three groups. Different papers study the possible relationship between facial growth patterns and dental and skeletal maturation. According to the reviewed literature, we can conclude that the patients who present a vertical growth pattern show more advanced dental and skeletal maturation in comparison with the patients who present a horizontal growth pattern


Assuntos
Humanos , Masculino , Feminino , Criança , Arco Dental/crescimento & desenvolvimento , Desenvolvimento Maxilofacial/fisiologia , Maxila/crescimento & desenvolvimento , Ossos Faciais/crescimento & desenvolvimento , Crânio/diagnóstico por imagem , Estudos Retrospectivos , Estudos Transversais , Estudos Longitudinais , Radiografia Panorâmica , Cefalometria/métodos
20.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 98-102, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-190378

RESUMO

Paciente varón de 50 años quien tras 3 meses de un traumatismo encefalocraneano presenta proptosis, quemosis y exoftalmos en el ojo izquierdo. Posteriormente desarrolla dismetría en las extremidades izquierdas y hemiparesia derecha. Se establece el diagnóstico de fístula carótido-cavernosa (FCC) asociado a hiperintensidad de señal en FLAIR y captación difusa de contraste al nivel de la protuberancia y pedúnculo cerebeloso, de aspecto pseudotumoral. Dicho hallazgo fue compatible con congestión venosa. Sus síntomas fueron fluctuantes; comenzó con síntomas orbitarios y luego de territorio posterior con mejoría de los síntomas orbitarios. La embolización con microcoils de la FCC produjo la resolución de los síntomas oculares seguido por mejoría de los síntomas de tronco encefálico. Los hallazgos en resonancia magnética revirtieron considerablemente al año de seguimiento. Describimos un caso de FCC directa con congestión venosa en el tronco encefálico y síntomas fluctuantes con una considerable mejoría clínica e imagenológica después del tratamiento


A 50-year-old male patient who, after 3 months of cranial brain trauma, presented proptosis, chemosis and exophthalmos in the left eye. Subsequently, dysmetria develops in the left extremities and right hemiparesis. The diagnosis of carotid-cavernous fistula (FCC) associated with hyperintensity of signal in FLAIR and diffuse contrast uptake at the level of the pseudo tumoral protuberance and cerebellar peduncle was established. This finding was compatible with venous congestion. His symptoms were fluctuating, he started with orbital symptoms and then from the posterior fossa with improvement of the orbital symptoms. FCC microcoil embolization produced resolution of ocular symptoms followed by improvement of brainstem symptoms. Magnetic resonance findings significantly reversed one year of follow-up. We describe a case of direct FCC with venous congestion in the brainstem and fluctuating symptoms with a considerable clinical and imaging improvement after treatment


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/cirurgia , Infarto Cerebral/etiologia , Tronco Encefálico/cirurgia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Traumatismos Cranianos Penetrantes/complicações , Exoftalmia/complicações , Espectroscopia de Ressonância Magnética , Crânio/diagnóstico por imagem , Embolização Terapêutica
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