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Adult skull fractures
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
If the dura/meninges are still intact, the location of a haematoma can be readily assessed and compared with the location of the fracture site and underlying brain injury. After removal of the brain, the dura around the base of the brain and inside the remaining calvarium should be removed carefully. In younger individuals, traction with soft tissue paper can do most of the stripping. In elderly individuals, the dura mater tends to adhere more to the skull and dural strippers may be employed. Once all the dura has been removed, the inside of the cranium should be carefully examined and again the fracture lines documented and photographed. Gentle traction on the skull will open up any fracture lines and make them more readily visible.
CSF Circulation and Disorders
Published in Swati Goyal, Neuroradiology, 2020
Subdural collection/hemorrhage − look for associated features like retinal hemorrhages, etc., in a child with a history of abuse. Cortical veins are displaced away from the inner table of calvaria, due to compression of SASs by subdural hygromas.
Regional injuries and patterns of injury
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The skeleton of the human head is divided into three main parts: the mandible, the facial skeleton and the closed container that contains the brain – the calvarium. The calvarium is made up of eight plates of bone, each of varying thickness, with buttresses passing through and across the bony margins. The skull is designed in part to protect the brain and in part to provide a mobile but secure platform for the receptor organs of the special senses.
Bone regeneration in rat using polycaprolactone/gelatin/epinephrine scaffold
Published in Drug Development and Industrial Pharmacy, 2021
Arian Ehterami, Hossein Khastar, Mostafa Soleimannejad, Majid Salehi, Simin Nazarnezhad, Jila Majidi Ghatar, Arindam Bit, Moslem Jafarisani, Ghasem Abbaszadeh-Goudarzi, Nabi Shariatifar
Figure 5 shows histopathological analysis of calvaria defects. While defect site in the group without scaffold was filled with a loose areolar connective tissue (LACT) (star) (contained haphazardly oriented immature collagen fibers, fibroblasts, and newly formed blood vessels), higher new bone and osteocyte in lacuna (OC) (thin yellow arrow) in the defect sites can be seen in PCL/GNF/EP0.1% and PCL/GNF/EP1% groups. Considering the PCL/GNF group, scaffold relatively degraded and almost substituted with new tissues comprising collagen fibers, mature bone (MB), and neo-bone (NB). Minimum bone ingrowth was seen in the negative control group. Higher angiogenesis (thin green arrow) and woven bone formation (thick arrow) also can be seen in the PCL/GNF/EP0.1% and PCL/GNF/EP1% groups. The negative control group had a higher degree of LACT. LACT, FT, OB, BM, NB, SCR, and AG.
Luckenschadel Associated with Chiari Type II Malformation: An Autopsy Case Report
Published in Fetal and Pediatric Pathology, 2021
The parents opted for termination of the pregnancy at 34 weeks gestation and accepted autopsy. Stillbirth occurred before termination. The female fetus weighed 2135 g with a crown to heel length of 23.5 cm, crown to rump length of 46 cm, which were consistent with gestational age of 34-35 weeks gestation. The head circumference measured 31 cm which was consistent with 35 weeks gestation. Skull X-ray showed a honeycomb appearance of the skull, compatible with lacunar skull (Figure 2). On macroscopic examination, the fetus was severely macerated. The 3.7 cm ruptured lumber myelomeningocele was associated with diastematomyelia (Figure 3). No visceral malformations were observed. The calvarium was thin and extensively fenestrated. The fenestrations, involving the parietal and occipital bones, were not covered by periosteum. The radiographic honeycomb appearance corresponded to the presence of multiple round, oval, or fingerlike radiolucent gaps which were in part covered by thin fibrous membrane and sharply outlined by dense boney ridges (Figure 4). Hydrocephalus could not be confirmed because of cerebral maceration. Histological examination of the viscera show no significant alterations.
Balancing the short-term benefits and long-term outcomes of decompressive craniectomy for severe traumatic brain injury
Published in Expert Review of Neurotherapeutics, 2020
A contemporary example of these issues is seen when considering the role of decompressive craniectomy in the management of severe traumatic brain injury [3]. Temporarily removing a large section of the calvarium provides extra space into which the injured brain can expand. The short-term goal of surgical intervention is to reduce mortality in the context of intracranial hypertension and many retrospective cohort studies have emphasized the lifesaving nature of the surgical intervention and the reduction in intracranial pressure (ICP) that can be achieved. What is less clear is the degree to which the reduction in ICP and the improvement in cerebral perfusion leads to the long-term goals of a good functional outcome that is acceptable to those that survive. These concerns have prompted researchers to conduct a number of large multicentre randomized controlled trials investigating the efficacy of surgical decompression, initially in the context of ischaemic stroke [4–8] and more recently in the context of severe traumatic brain injury [9,10].