RESUMEN
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
OBJECTIVE: The aim of this study was to describe the anatomical features encountered in the parietal foramen in a series of 178 human bones and 123 head MRI examinations. A cadaveric specimen was also dissected to demonstrate the trajectory of a superficial scalp vein through the parietal foramen as far as the dura mater. A literature review was performed regarding prevalence of parietal foramen in different populations. METHODS: Totally, 178 paired adult bones were used to investigate the presence, shape and number of the parietal foramina. In addition, 123 brain MRI examinations were also studied. RESULTS: The parietal foramina were encountered in 75/89 (84.3%) skulls [32/38 (84.2%) in women vs. 43/51 (84.3%) in men, p > 0.05]. The parietal foramen was present bilaterally in 44.73% of females and 54.9% of males. Regarding unilaterality of the parietal foramen, a right or left laterality was observed in female 21% right versus 18% left; and 16% versus 14% (left) in males (p > 0.05). The accessory parietal foramen was present in the right parietal in 2.6% and in 7.9% on the left side of the females, while 5.9% and 3.9% of the males on the right or left sides, respectively. The parietal foramina located in the proximity of the sagittal suture (male 7.1 ± 2.5 mm vs. female, 7.4 ± 2.7 mm). There was a positive correlation between the right and left parietal foramina regarding the distance from the median line. The distance from a foramen to the contralateral one was 16 ± 4 mm in men and 18 ± 5 mm in women, respectively (p > 0.05). CONCLUSION: No major differences were encountered between sexes regarding the anatomical features of parietal foramen.
Asunto(s)
Variación Anatómica , Hueso Parietal/irrigación sanguínea , Cuero Cabelludo/irrigación sanguínea , Venas/anatomía & histología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cadáver , Disección , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Hueso Parietal/diagnóstico por imagen , Prevalencia , Cuero Cabelludo/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Surgical resection of maxillary tumors can result in defects that can be difficult to reconstruct by conventional means due to the complex functional and anatomic nature of the midface and lack of regional bone flap options in the head and neck. Many reconstructive methods have been used to repair maxillary defects, but the ideal technique for the reconstruction of hemi-maxillectomy defects in growing pediatric patients has yet to be determined. METHODS: The authors present a rare pediatric patient with melanotic neuroectodermal tumor of infancy resulting in a hemi-maxillectomy defect after resection that was reconstructed using a pedicled vascularized composite flap consisting of temporalis muscle, pericranium, and parietal bone. RESULTS: The patient achieved successful long-term bony reconstruction of his right maxilla with this flap. Stable skeletal fixation with adequate orbital support was maintained over a >3-year follow-up period. CONCLUSION: A vascularized composite parietal bone flap is a reliable reconstructive option for reconstruction of large maxillectomy defects providing low donor-site morbidity, adequate globe support, excellent long-term skeletal stability, and malar symmetry in rapidly growing pediatric patients. Successful reconstruction for a rare patient with maxillary melanotic neuroectodermal tumor of infancy requiring hemi-maxillectomy was demonstrated with >3-year follow-up.
Asunto(s)
Maxilar/cirugía , Neoplasias Maxilares/cirugía , Melanoma/cirugía , Hueso Parietal/cirugía , Procedimientos de Cirugía Plástica , Craneotomía , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Maxilar/irrigación sanguínea , Maxilar/diagnóstico por imagen , Maxilar/patología , Neoplasias Maxilares/irrigación sanguínea , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Maxilares/patología , Hueso Parietal/irrigación sanguínea , Hueso Parietal/diagnóstico por imagen , Colgajos Quirúrgicos/cirugía , Músculo Temporal/cirugía , Cigoma/cirugíaRESUMEN
Hyaluronic acid (HA) filler injection is widely used for soft-tissue augmentation. Complications associated with HA filling are not uncommon; however, HA-induced alopecia is a rarely reported complication that could result in severe secondary psychological trauma. The etiology, clinical traits, treatment strategies, outcomes, and possible reversibility of HA-induced alopecia have not been characterized. Here, we report a case in which bilateral temple injections of 6.5 mL of HA led to persistent pain over the left scalp for several days. Although the pain was relieved at day 9 after 600 U of hyaluronidase were injected in the left temple, the patient developed localized alopecia at the left temporoparietal region with central skin necrosis at day 15. After topical applications of recombinant bovine basic fibroblast growth factor gel and 2% minoxidil spay, the necrotic skin wound was healed at day 42. Hair regrowth and normal hair density were restored at day 74. Analyses of Doppler ultrasound examinations and histopathology of the skin biopsy suggested that mild ischemia of the left temporoparietal region led to reversible alopecia, while the permanent hair loss in the left parietal area was associated with severe skin ischemia. Therefore, the key to treatment would be to focus on the effective correction of severe ischemia-induced skin necrosis to prevent permanent hair loss. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Alopecia/inducido químicamente , Arteriopatías Oclusivas/inducido químicamente , Rellenos Dérmicos/efectos adversos , Cabello/crecimiento & desarrollo , Ácido Hialurónico/efectos adversos , Hueso Parietal/irrigación sanguínea , Cuero Cabelludo/patología , Adulto , Alopecia/diagnóstico por imagen , Alopecia/patología , Arteriopatías Oclusivas/patología , Arterias/patología , Biopsia con Aguja , Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/farmacología , Femenino , Estudios de Seguimiento , Humanos , Ácido Hialurónico/administración & dosificación , Inmunohistoquímica , Minoxidil/uso terapéutico , Necrosis/etiología , Necrosis/patología , Hueso Parietal/efectos de los fármacos , Recuperación de la Función , Cuero Cabelludo/irrigación sanguínea , Cuero Cabelludo/efectos de los fármacos , Ultrasonografía Doppler en Color/métodosRESUMEN
In the late 18th and early 19th centuries, Dr. John Howship, a pioneering British surgeon, described the clinical features and pathophysiology of various surgical disorders of the human body. His critical contributions to pediatric neurosurgery came in 1816 when he first described the features of an important childhood condition following head trauma, what he referred to as parietal bone absorption. This condition as depicted by Dr. Howship was soon to be christened by later scholars as traumatic cephalhydrocele, traumatic meningocele, leptomeningeal cyst, meningocele spuria, fibrosing osteitis, cerebrocranial erosion, and growing skull fracture. Nevertheless, the basic features of the condition as observed by Dr. Howship were virtually identical to the characteristics of the above-mentioned disorders. This article describes the life and accomplishments of Dr. Howship and his contributions to the current understanding of growing skull fracture.
Asunto(s)
Duramadre/lesiones , Encefalocele/historia , Neurocirugia/historia , Hueso Parietal/lesiones , Fracturas Craneales/historia , Quistes Aracnoideos/complicaciones , Quistes Aracnoideos/cirugía , Resorción Ósea/etiología , Resorción Ósea/fisiopatología , Trasplante Óseo , Preescolar , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/fisiopatología , Progresión de la Enfermedad , Duramadre/patología , Encefalocele/clasificación , Encefalocele/etiología , Encefalocele/cirugía , Cirugía General/historia , Historia del Siglo XVIII , Historia del Siglo XIX , Humanos , Lactante , Londres , Museos , Hueso Parietal/irrigación sanguínea , Hueso Parietal/fisiopatología , Prótesis e Implantes , Procedimientos de Cirugía Plástica , Fracturas Craneales/clasificación , Fracturas Craneales/etiología , Fracturas Craneales/cirugíaRESUMEN
It remains unknown whether bone graft vascularity influences calvarial healing. The purposes of this study were (1) to develop a model to study nonvascularized and vascularized calvarial grafts as well as (2) to compare effects of bone graft vascularity on calvarial healing. Bilateral calvarial defects were created in 26 Wistar rats. The defects were left empty within 1 parietal region. On the contralateral side, the defects were partially closed with native parietal bone (control group, n = 6), nonvascularized (N-V, n = 10), or vascularized bone grafts (VAS, n = 10). The vascularized grafts were supplied by perforating dural arterioles. Bone mineralization and healing patterns from serial microcomputed tomographic scans were compared within and across the groups using parametric and nonparametric tests. Differences in bone mineral content across sides were significant between the groups at weeks 6 (P = 0.016) and 12 (P = 0.025). Bone formation was greater within both the control and VAS groups versus the N-V group at weeks 6 and 12 (P < 0.05). Healing patterns differed between the groups (P < 0.05), progressing through islands of new bone formation within the control and VAS groups while limited to defect margins on the N-V graft side. In conclusion, a bilateral calvarial defect model was established to study bone graft vascularity. Bone quantity and healing patterns differed in the presence of the nonvascularized versus vascularized grafts. Although the calvarial defect model is often applied within the plastic surgery literature to study bone substitutes, greater understanding of basic mechanisms influencing calvarial healing is first needed to avoid confounding results.
Asunto(s)
Trasplante Óseo/métodos , Hueso Parietal/cirugía , Procedimientos de Cirugía Plástica/métodos , Análisis de Varianza , Animales , Densidad Ósea/fisiología , Modelos Animales de Enfermedad , Masculino , Osteogénesis/fisiología , Hueso Parietal/irrigación sanguínea , Hueso Parietal/diagnóstico por imagen , Ratas , Ratas Wistar , Cicatrización de Heridas/fisiología , Microtomografía por Rayos XRESUMEN
BACKGROUND: Although bone repair is often a relatively rapid and efficient process, many bone defects do not heal. Because an adequate blood supply is essential for new bone formation, we hypothesized that augmenting new blood vessel formation by increasing the number of circulating vasculogenic progenitor cells (PCs) with AMD3100 and enhancing their trafficking to the site of injury with recombinant human parathyroid hormone (rhPTH) will improve healing. METHODS: Critical-sized 3-mm cranial defects were trephined into the right parietal bone of C57BLKS/J 6 mice (N = 120). The mice were divided into 4 equal groups (n = 30 for each). The first group received daily subcutaneous injections of AMD3100 (5 mg/kg). The second group received daily subcutaneous injections of rhPTH (5 mg/kg). The third group received both AMD3100 and rhPTH. The fourth group received subcutaneous injections of saline. Circulating vasculogenic PC numbers, new blood vessel formation, and bony regeneration were assessed. Progenitor cell adhesion, migration, and tubule formation were assessed in the presence of rhPTH and AMD3100. RESULTS: Flow cytometry demonstrated that combination therapy significantly increased the number of circulating PCs compared with all other groups. In vitro, AMD3100-treated PCs had significantly increased adhesion migration, and tubule formation was assessed in the presence of rhPTH. Combination therapy significantly improved new blood vessel formation in those with cranial defect compared with all other groups. Finally, bony regeneration was significantly increased in the combination therapy group compared with all other groups. CONCLUSIONS: The combination of a PC-mobilizing and traffic-enhancing agent improved bony regeneration of calvarial defects in mice.
Asunto(s)
Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Compuestos Heterocíclicos/uso terapéutico , Hormona Paratiroidea/uso terapéutico , Células Madre/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Animales , Bencilaminas , Regeneración Ósea/efectos de los fármacos , Adhesión Celular/efectos de los fármacos , Movimiento Celular/efectos de los fármacos , Ciclamas , Modelos Animales de Enfermedad , Citometría de Flujo , Compuestos Heterocíclicos/farmacología , Humanos , Ratones , Ratones Endogámicos C57BL , Neovascularización Fisiológica/efectos de los fármacos , Hormona Paratiroidea/farmacología , Hueso Parietal/irrigación sanguínea , Hueso Parietal/lesiones , Proteínas Recombinantes/uso terapéutico , Células Madre/citologíaRESUMEN
OBJECTIVE: This study examined the effect of basic fibroblast growth factor (FGF)-2 with an absorbable collagen sponge on angiogenesis and bone regeneration in rat calvarial critical-sized bone defects using microcomputed tomography. METHODS: Forty 7-week-old male Fischer rats were used. The symmetrical critical-sized calvarial bone defects (5 mm diameter) were created. An absorbable collagen sponge with or without FGF-2 (0.1% or 0.3%) was implanted into each bone defect. RESULTS: Blood vessel and bone volumes were significantly higher in the 0.3% FGF-2 group compared with the control and 0.1% FGF-2 groups on day 28. Significantly more osteoblast- and osteoclast-like cells were seen in the 0.3% FGF-2 group. CONCLUSIONS: Thus, FGF-2 increased blood vessel and bone formation in rat calvarial critical-sized bone defects.
Asunto(s)
Enfermedades Óseas/cirugía , Regeneración Ósea/efectos de los fármacos , Factor 2 de Crecimiento de Fibroblastos/uso terapéutico , Neovascularización Fisiológica/efectos de los fármacos , Hueso Parietal/cirugía , Implantes Absorbibles , Animales , Enfermedades Óseas/patología , Colágeno , Medios de Contraste , Procesamiento de Imagen Asistido por Computador/métodos , Yopamidol , Masculino , Microvasos/efectos de los fármacos , Microvasos/patología , Osteoblastos/efectos de los fármacos , Osteoblastos/patología , Osteoclastos/efectos de los fármacos , Osteoclastos/patología , Osteogénesis/efectos de los fármacos , Hueso Parietal/irrigación sanguínea , Ratas , Ratas Endogámicas F344 , Factores de Tiempo , Ingeniería de Tejidos/métodos , Andamios del Tejido , Pantallas Intensificadoras de Rayos X , Microtomografía por Rayos X/métodosRESUMEN
Enlarged parietal foramina (>5 mm) is an extremely rare developmental defect of the parietal bone, which is distinguished from the normal small parietal foramina, as genes associated with this entity have been identified, suggesting that it is hereditary in nature. We describe a dry skull of a 35-year-old female, with enlarged parietal foramina symmetrically situated bilaterally, oval in shape, measuring 4.5 × 9.3 mm (right) and 4.9 × 9.2 mm (left) in size. The foramina coexisted with multiple Wormian bones in several sites of the skull. On the inner parietal bone surface, the anterior, posterior and lateral foramina's rims carried grooves, which were continuous with the middle meningeal vessels' branches, indicating that a rich vascular network existed around the foramina. These vascular grooves also notched the external table at the margin of the foramina, which suggests a potential communication between the meningeal and the scalp vessels. In addition, this vascular variation should be taken into consideration when performing surgical interventions in the area, because the large vascular supply to the foramina is a possible source of extensive bleeding. Moreover, the interaction of intracranial and extracranial veins and the fact that the blood flows in them in both directions, as they are valveless, could represent a possible pathway for infections to spread in the cranial cavity.
Asunto(s)
Suturas Craneales/patología , Encefalocele/patología , Hueso Parietal/irrigación sanguínea , Hueso Parietal/patología , Adulto , Vasos Sanguíneos , Femenino , HumanosRESUMEN
Hyperbaric oxygen (HBO) therapy is used to treat or prevent tissue necrosis in patients undergoing irradiation. Many such patients require reconstructive surgery, but little is known of the effects of HBO on bone vascularization and regeneration. In this study, copolymer poly(l-lactide-co-1,5-dioxepan-2-one) (poly(LLA-co-DXO)) scaffolds were implanted into critical-sized calvarial defects in Wistar rats. The animals were randomly allotted to hyperbaric or normobaric oxygen groups. The treatment group received five sessions weekly for 90 min at increased atmospheric pressure, for up to 4 weeks. Samples were retrieved at weeks 2 and 8, i.e. after a total of 10 and 20 sessions, respectively. The samples were analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) and histology at week 2, and radiographically and histologically at week 8. At week 2, defects treated with HBO exhibited greater numbers of cells positive for the endothelial marker CD31, up-regulated gene expression of osteogenic markers, and down-regulated expression of pro-inflammatory cytokines. At week 8, radiographic examination revealed that calvarial defects subjected to HBO exhibited a higher percentage of radiopacities than normobaric controls, and histological examination disclosed enhanced bone healing. These results confirmed that HBO treatment was effective in stimulating vascularization and bone formation in rat calvarial defects.
Asunto(s)
Regeneración Ósea/fisiología , Citocinas/análisis , Oxigenoterapia Hiperbárica/métodos , Neovascularización Fisiológica/fisiología , Hueso Parietal/irrigación sanguínea , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/análisis , Ingeniería de Tejidos/métodos , Animales , Regeneración Ósea/genética , Resorción Ósea/terapia , Modelos Animales de Enfermedad , Femenino , Expresión Génica , Neovascularización Fisiológica/genética , Poliésteres , Distribución Aleatoria , Ratas , Ratas Wistar , Reacción en Cadena en Tiempo Real de la Polimerasa , Andamios del TejidoRESUMEN
OBJECTIVES: Restoration of an adequate blood supply is essential for the bone healing process and is key to the success of bone augmentation procedures. In this study, we evaluated angiogenesis in rat calvarial flat bone defects using in vivo microfocus computed tomography (micro-CT). MATERIALS AND METHODS: Twenty rats were used. The calvarium was exposed and calvarial bone defects of critical (5-mm diameter) and non-critical (2.7-mm diameter) sizes were prepared. Bone regeneration and angiogenesis were evaluated by image analysis using micro-CT and histological examination. RESULTS: Critical- and non-critical-sized calvarial bone defects showed bone regeneration and angiogenesis around the midsagittal suture. Critical-sized calvarial bone defects showed approximately 1.2% reossification of the original surgical defect, whereas the non-critical-sized defects showed approximately 43.3% reossification at day 28. Furthermore, angiogenesis was observed later in the critical-sized calvarial bone defects (about 38.2%), whereas angiogenesis was observed early in the non-critical-sized calvarial bone defects (about 75.5%) at day 28. New blood vessel networks were observed around defects of both sizes. CONCLUSIONS: Angiogenesis preceded bone regeneration around critical- and non-critical-sized calvarial bone defects. Angiogenesis led to full bone formation in non-critical-sized defects.
Asunto(s)
Regeneración Ósea/fisiología , Neovascularización Fisiológica/fisiología , Hueso Parietal/irrigación sanguínea , Microtomografía por Rayos X/métodos , Angiografía/métodos , Animales , Enfermedades Óseas/patología , Enfermedades Óseas/fisiopatología , Tejido Conectivo/irrigación sanguínea , Tejido Conectivo/patología , Suturas Craneales/irrigación sanguínea , Suturas Craneales/fisiología , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Osteogénesis/fisiología , Hueso Parietal/fisiopatología , Hueso Parietal/cirugía , Ratas , Ratas Endogámicas F344 , Factores de TiempoRESUMEN
BACKGROUND: Although bone repair is a relatively efficient process, a significant portion of patients fail to heal their fractures. Because adequate blood supply is essential to osteogenesis, the authors hypothesize that augmenting neovascularization by increasing the number of circulating progenitor cells will improve bony healing. METHODS: Bilateral full-thickness defects were created in the parietal bones of C57 wild-type mice. Intraperitoneal AMD3100 (n = 33) or sterile saline (n = 33) was administered daily beginning on postoperative day 3 and continuing through day 18. Circulating progenitor cell number was quantified by fluorescence-activated cell sorting. Bone regeneration was assessed with micro-computed tomography. Immunofluorescent CD31 and osteocalcin staining was performed to assess for vascularity and osteoblast density. RESULTS: AMD3100 treatment increased circulating progenitor cell levels and significantly improved bone regeneration. Calvarial defects of AMD3100-treated mice demonstrated increased vascularity and osteoblast density. CONCLUSIONS: Improved bone regeneration in this model was associated with elevated circulating progenitor cell number and subsequently improved neovascularization and osteogenesis. These findings highlight the importance of circulating progenitor cells in bone healing and may provide a novel therapy for bone regeneration.
Asunto(s)
Regeneración Ósea/fisiología , Movilización de Célula Madre Hematopoyética/métodos , Neovascularización Fisiológica/fisiología , Osteogénesis/fisiología , Células Madre/fisiología , Animales , Bencilaminas , Regeneración Ósea/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Remodelación Ósea/fisiología , Recuento de Células , Ciclamas , Modelos Animales de Enfermedad , Compuestos Heterocíclicos/farmacocinética , Masculino , Ratones , Ratones Endogámicos C57BL , Neovascularización Fisiológica/efectos de los fármacos , Osteoblastos/efectos de los fármacos , Osteoblastos/patología , Osteogénesis/efectos de los fármacos , Hueso Parietal/irrigación sanguínea , Hueso Parietal/lesiones , Hueso Parietal/patología , Receptores CXCR4/antagonistas & inhibidores , Células Madre/citología , Células Madre/efectos de los fármacos , Microtomografía por Rayos XRESUMEN
The superficial temporal artery (STA)-based flaps have been used for different reconstructive purposes. These operations may cause facial nerve injury. The variations of the STA and its relation to temporal branch of the facial nerve (TBFN) were evaluated in this study. Thirteen cadavers with 26 STA and TBFN have been dissected. The bifurcation of STA was found to be 60% above the superior border of the zygomatic arc and 40% below this level. The mean lengths of frontal and temporal branches (FB and TB) of STA were 11.5 and 11.4 cm, respectively. The mean numbers of perforators of FB and TB to deep plane were 1.30 and 1.34, respectively. The mean diameter of STA at the superior border of zygomatic arc was 2.5 mm. The mean diameters of TB and FB at the level of bifurcation were 1.8 mm and 2.0 mm, respectively. The mean number of TBFN at the level of zygomatic arc was 3.70. The mean distance of the first and last branching of TBFN to tragus was found to be 24 mm. The mean number of TBFN at the level of the middle orbita was found to be 2.7. The mean distance of first and last branches of TBFN to the lateral orbital rim was 12 and 24 mm, respectively. The results found in this study may increase the accuracy of flaps based on STA and decrease the risk of facial nerve paralysis during these operations.
Asunto(s)
Nervio Facial/anatomía & histología , Arterias Temporales/anatomía & histología , Músculo Temporal/inervación , Cadáver , Disección , Oído Externo/irrigación sanguínea , Hueso Frontal/irrigación sanguínea , Humanos , Órbita/irrigación sanguínea , Hueso Parietal/irrigación sanguínea , Colgajos Quirúrgicos/patología , Cigoma/irrigación sanguíneaAsunto(s)
Anemia de Células Falciformes/complicaciones , Arteriopatías Oclusivas/diagnóstico , Edema/etiología , Anemia de Células Falciformes/patología , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/patología , Preescolar , Cara , Femenino , Hueso Frontal/irrigación sanguínea , Humanos , Meninges/patología , Hueso Parietal/irrigación sanguínea , Columna Vertebral/irrigación sanguínea , Tomografía Computarizada por Rayos XRESUMEN
OBJECT: There are few systematic investigations of the dissected surgical anatomy of the diploic venous system (DVS) in the neuroanatomical literature. The authors describe the DVS relative to different common neurosurgical approaches. Knowledge of this system can help avoid potential sources of unacceptable bleeding and may impact healing of the cranium. METHODS: Using a high-speed drill with a 2-mm bit, the authors removed the outer layer of the compact bone in the skull to expose the DVS in 12 formalin-fixed cadaver heads. Pterional, supraorbital, and modified orbitozygomatic craniotomies were performed to delineate the relationship of the DVS. RESULTS: The draining point of the frontal diploic vein (FDV) was located near the supraorbital notch. The draining point of the anterior temporal diploic vein (ATDV) was located in all pterional areas; the draining point of the posterior temporal diploic vein (PTDV) was located in all asterional areas. The PTDV was the dominant diploic vessel in all sides. The FDV and ATDV could be damaged during supraorbital, modified orbitozygomatic, and pterional craniotomies. The anterior DVS connected with the sphenoparietal and superior sagittal sinus (SSS). The posterior DVS connected with the transverse and sigmoid sinuses and was the dominant diploic vessel in all 24 sides. Of all the major diploic vessels, the location and pattern of distribution of the FDV were the most constant. The parietal bone contained the most diploic vessels. No diploic veins were found in the area delimited by the temporal squama. CONCLUSIONS: The pterional, orbitozygomatic, and supraorbital approaches place the FDV and ATDV at risk. The major anterior diploic system connects the SSS with the sphenoparietal sinus. The posterior diploic system connects the SSS with the transverse and sigmoid sinuses.
Asunto(s)
Procedimientos Neuroquirúrgicos/métodos , Cráneo/irrigación sanguínea , Venas/anatomía & histología , Cadáver , Seno Cavernoso/anatomía & histología , Venas Cerebrales/anatomía & histología , Craneotomía/métodos , Duramadre/anatomía & histología , Duramadre/irrigación sanguínea , Humanos , Hueso Parietal/irrigación sanguínea , Cráneo/anatomía & histología , Seno Sagital Superior/anatomía & histología , Hueso Temporal/irrigación sanguínea , Venas/cirugíaRESUMEN
The morphogenesis and evolution of the cranium are the result of structural interactions among its components, leading to covariance between traits. Soft and hard tissues exert a reciprocal physical and physiological influence, leading to the final phenotype in terms of both ontogeny and evolution. The middle meningeal vessels, interfacing the brain and the braincase, provide an opportunity to study this network, even in extinct human species. Between and within-species variations of the vascular patterns may be mechanically influenced by the cranial morphology (structural hypothesis) or else by actual physiological responses and adaptations, mostly related to oxygen supply and/or thermoregulation (functional hypothesis). In this analysis, we tested the relationship between neurocranial shape and the general morphology of the traces of the middle meningeal vessels in a modern human population, by using landmark-based geometrical models. Although there are some neurocranial differences between groups with different vascular patterns, they are very small or not statistically significant. Only the depth of the imprints may be more influenced by the endocranial morphology. Even if the neurocranial differences among extinct hominids are definitely larger than those within the modern species, the present analysis suggests that it is unlikely that the differences in vascular patterns among the human species are related only to the effects of different neurocranial geometry. This is rather relevant when the marked development of the meningeal network in Homo sapiens is taken into account, compared with the patterns described for nonmodern human species.
Asunto(s)
Fosa Craneal Media/irrigación sanguínea , Fosa Craneal Media/embriología , Arterias Meníngeas/embriología , Neovascularización Fisiológica/fisiología , Cráneo/irrigación sanguínea , Cráneo/embriología , Adulto , Antropometría/métodos , Simulación por Computador , Fosa Craneal Media/fisiología , Embriología/métodos , Femenino , Hueso Frontal/irrigación sanguínea , Hueso Frontal/embriología , Humanos , Masculino , Arterias Meníngeas/fisiología , Persona de Mediana Edad , Hueso Parietal/irrigación sanguínea , Hueso Parietal/embriología , Cráneo/fisiología , Hueso Esfenoides/irrigación sanguínea , Hueso Esfenoides/embriología , Hueso Temporal/irrigación sanguínea , Hueso Temporal/embriología , Hueso Temporal/fisiologíaRESUMEN
INTRODUCTION: Intradiploic cavernous hemangioma of the skull is seen rarely. Intradiploic cavernous hemangiomas arise from the intrinsic vasculature of the bone and generally picks up at the fourth and fifth decades. DISCUSSION AND CONCLUSION: In this report, we present a 16-year-old child who was admitted with a swelling lesion in the right parietal bone and diagnosed as cavernous hemangioma after total extirpation.
Asunto(s)
Hemangioma Cavernoso/cirugía , Hueso Parietal/irrigación sanguínea , Neoplasias Craneales/cirugía , Adolescente , Hemangioma Cavernoso/patología , Humanos , Masculino , Hueso Parietal/patología , Neoplasias Craneales/patología , Resultado del TratamientoRESUMEN
Here we describe an 8-year old male child with homozygous sickle cell disease who presented with left parietal skull bone infarction and, during his stay in hospital, developed a right femoral deep vein thrombosis (DVT), both uncommon complications of the disease. He initially presented with severe headache and generalised tenderness of the calvarium, which did not respond to simple analgesics. Scalp swelling in and around the left frontal (including left orbit) and parietal regions developed 24 h after presentation. The differential diagnosis included incipient stroke, acute sickle bone crisis and osteomyelitis, with a possible complication of epidural haematoma, or orbital compression syndrome. An initial exchange blood transfusion did not lead to appreciable reduction in opiate requirements. Significant symptomatic relief was attained only after a second exchange transfusion. The DVT developed at the site of catheterisation (right femoral vein), and this was treated with maximal doses of enoxaparin followed by warfarin. The child is now well and off anti-coagulants. In this article we present a review of the literature and discuss possible mechanisms of these complications in our patient.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Infarto/etiología , Hueso Parietal/irrigación sanguínea , Tromboflebitis/etiología , Anticoagulantes/uso terapéutico , Cateterismo/efectos adversos , Niño , Diagnóstico Diferencial , Edema/etiología , Enoxaparina/uso terapéutico , Recambio Total de Sangre , Vena Femoral , Cefalea/etiología , Humanos , Infarto/diagnóstico , Masculino , Osteomielitis/diagnóstico , Accidente Cerebrovascular/diagnóstico , Trombofilia/etiología , Warfarina/uso terapéuticoRESUMEN
OBJECTIVE: The early effect of platelet-rich plasma (PRP) on bone regeneration in combination with dense biphasic hydroxyl apatite (HA)/beta-tricalcium phosphate (TCP) particles (ratio 60%/40%) was evaluated in rat cranial defects with a diameter of 6.2 mm. We hypothesize that PRP exerts its beneficial effect on bone regeneration within the first and second week after application in a bone defect combined with an osteoconductive material. MATERIALS AND METHODS: Forty-five rats were used in the study, in which always one cranial defect was created. The defects were filled with HA/beta-TCP particles and HA/beta-TCP particles combined with PRP gel. Some defects were also left unfilled as control. One and two weeks after surgery specimens were retrieved for light microscopy [hematoxylin-eosin, trichrome staining (Masson modification Goldner) and basic fuchsin-methylene blue] and micro-CT analysis to evaluate bone formation and neovascularization. One-way analysis of variance was performed on the raw data obtained from micro-CT analyses. RESULTS: The histological evaluation showed no effect of PRP on bone formation and neovascularization for both implantation times. In the first week, the defect closure was evaluated subjectively to be between 10% and 50% in all samples, whereas no difference among the groups appeared to occur. After 2 weeks, complete bridging of the original bone defect was observed for most of the empty defects, as well as for the defects that contained HA/beta-TCP particles. The trichrome staining revealed no difference in the number of blood vessels between the PRP and non-PRP groups for both implantation times. The osteoconductive nature of dense HA/beta-TCP particles was confirmed, as the bone formation was guided by their outer surfaces and resulted in a larger amount of newly formed bone in comparison with the empty defects. The quantitative micro-CT analysis demonstrated a statistically significant difference in new bone formation between the empty defects and defects filled with particles after 1 week of implantation, but there was no difference between the non-PRP and PRP groups. In at the second week, no difference in bone formation among all groups was observed, whereas even the non-filled control defects were almost completely closed. CONCLUSIONS: A 6.2 mm cranial defect is not a critical-sized defect in rats. Rat PRP had no effect on the early stages of bone healing in addition to an osteoconductive material. Dense HA/beta-TCP particles showed a beneficial effect on bone formation already after 1 and 2 weeks of implantation in non-critical-sized cranial defects in rats.
Asunto(s)
Enfermedades Óseas/cirugía , Regeneración Ósea/fisiología , Sustitutos de Huesos/uso terapéutico , Hueso Parietal/cirugía , Plasma Rico en Plaquetas/fisiología , Animales , Enfermedades Óseas/patología , Fosfatos de Calcio/uso terapéutico , Colorantes , Modelos Animales de Enfermedad , Durapatita/uso terapéutico , Masculino , Microrradiografía , Neovascularización Fisiológica/fisiología , Osteogénesis/fisiología , Hueso Parietal/irrigación sanguínea , Ratas , Ratas Endogámicas F344 , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Orbital wall infarction and subperiosteal haematomas are unusual manifestations of sickling disorders. Here we report an 11-year-old girl with sickle cell anaemia having multiple skull infarctions including the orbital bony structures associated with subperiosteal haematomas. The diagnosis was made by MRI, which showed bone marrow changes and associated haemorrhagic collections. The patient was successfully managed without surgical intervention.