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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The patient in the case vignette has osteogenesis imperfecta (OI). This is rare disorder due to a defect in type 1 collagen formation which causes brittle bones with a tendency to fracture. Typical radiographic features of the appendicular skeleton include poor bone density, bone deformity (e.g. shepherd’s crook deformity) and evidence of previous fractures. The presence of >10 wormian bones may be seen in OI. An important differential diagnosis is non-accidental injury. Subdural haematoma and optic nerve atrophy are not associated with OI. Ground glass appearance of the sphenoid wing may be seen in fibrous dysplasia. Widening of the diploe is seen in sickle cell anaemia and thalassaemia.
How to revise a failed occipital cervical fusion
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Joshua T. Wewel, Mazda K. Turel, Joseph E. Molenda, Vincent C. Traynelis
The other potential technique if there has been a large posterior fossa craniectomy is to place screws into the diploe of the calvarium (Video 11.1). This is akin to iliac crest screw placement. Guide holes are made through the diploic space, and screws are placed. The screw diameter should be tailored to each patient such that cortical bone is engaged yet not violated by screw threads. The diploic screws can then be fixed to the cervical instrumentation. The procedure requires careful preoperative planning and is best performed using image guidance.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
Most of the bones in the neurocranium are flat or diploic bones consisting of two tables enclosing a medullary cavity with red bone marrow. The inner table is thin and brittle, while the outer table is thick and resilient. The diploe do not form where the skull is covered with muscles, leaving the vault thin and prone to fracture. The skull bones vary in thickness in different regions—it is thickened at the glabella, occipital protuberance, mastoid processes, and external angular process of the frontal bone. The thinnest part of the cranium, particularly prone to fractures, is the pterion, an H-shaped junction between the frontal, temporal, parietal, and sphenoid bones. A fracture here can lacerate the underlying middle meningeal artery, resulting in an extradural hematoma. The bones in the viscerocranium are rather delicate and hence susceptible to fracture.
Gall’s German enemies
Published in Journal of the History of the Neurosciences, 2020
But what about Gall’s more controversial skull theory? Ackermann started his section on it in a rather blunt way, contending, “Gall did not know the structure of the brain, and he knew as little of the structure of the skull (Ackermann 1806, 53).” He then turned to the rationale behind Gall’s craniology—the assumption that the surface of the skull truthfully reflects bumps and depressions of the underlying brain. This is the assumption of parallelism, which Gall was promoting as dogma. Ackermann warned that, although this might be correct in general, it might not hold for all parts of the skull and perhaps not for every individual. He gave two main reasons for deviations from this parallelism. The first involved the muscles that draw the bones upward or downward, and the second is the air that creeps into various areas in the brain and enlarges spaces among cells in the diploë. He then stated, “Dr. Gall’s presentation of the formation of [skull] bones is entirely wrong” (1806, 55), in particular when he was maintaining that these bones “model themselves according to the form of the brain, that is, that they draw back when the brain grows, and sink, indeed thicken, if the brain mass decreases at some spot” (1806, 55).
A comparative analysis of piezosurgery and oscillating saw for balanced orbital decompression
Published in Orbit, 2019
Kerstin Stähr, Anja Eckstein, Laura Holtmann, Anke Schlüter, Meaghan Dendy, Stephan Lang, Stefan Mattheis
Piezosurgery does not lead to tissue damage caused by overheating when using self-irrigation according to histological findings.23,24 Whether there are differences in the healing processes after using a micro-saw or piezosurgery remains unclear. Aro et al. found no significant difference in the bony microstructure or the healing process.25 Maurer et al. described an integrated bony structure after the use of piezosurgery, while the use of a micro-saw caused damage to the diploe structure.26 No complications or differences in the healing process of the bony transplant were seen in our two groups, so therefore, we conclude correct handling of both devices with integrated irrigation has comparable effect on the treated bone. Thus, the fact that piezosurgery only cuts bone while the soft tissue stays intact, seems to promote the application for orbital decompression 27 While removing the bony lateral orbit, accidental injury to the periorbita, dura, muscles of nerves will have a negative impact on the surgical outcome. A thin cutting groove and a preserved bony microstructure rendered possible by piezosurgery also benefits replantation of a thin lateral orbital rim.
Skull angiosarcoma associated with a calcified chronic subdural hematoma
Published in British Journal of Neurosurgery, 2023
Guowen Qin, Peng Xu, Shengyong Lan, Yipu Mao, Yongta Huang, Jin Ye, Youming Liang
Development of calcification by a chronic subdural hematoma generally requires 6 months to several years to occur.10 Therefore, the CSDH had most likely existed for a long time prior to its initial diagnosis. At age 58 our patient was at risk of CSDH. The mean age of patients in most CSDH case series ranges from 55 to 60 years.11 Except for the accident reported above, our patient denied having any history of head trauma. The initial MRI showed that the high signal due to diploe in T1WI was absent, suggesting that the tumor had existed for a long time before it was first found in conjunction with a CSDH. Therefore, we cannot be certain whether the subdural hematoma or the tumor came first.