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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Laterally, the vault is composed of the parietal and temporal bones whereas the posterior part is made up from the occipital bone. The occipital bone extends inferiorly into the base of the skull and is pierced by the large foramen magnum, the entry point of the spinal cord into the internal skull. The bones of the skull articulate with each other by fibrous joints called sutures, namely the coronal, sagittal and lambdoid sutures.
Revision suboccipital decompression for complex Chiari malformation
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob L. Goldberg, Ibrahim Hussain, Ali A. Baaj, Jeffrey P. Greenfield
After the patient is positioned and draped, the original incision is opened. Based on the goals of revision surgery, this incision can be extended as needed. As mentioned previously, identifying normal anatomy is performed first. At the cranial aspect, normal occipital bone is identified. A small two- or three-prong Weitlaner retractor is placed. Gentle retraction can help identify the midline or natural planes of the deeper soft tissues. Monopolar cautery can be used carefully to open the remainder of the superficial tissue. Once fascia is identified, extreme caution needs to be taken with monopolar cauterization to avoid incidental durotomy. At the caudal aspect, the spinous process of C2 is identified and superior aspect of the C2 lamina is exposed, taking care not to unroof the C1/2 joints bilaterally, which can result in instability. Single- or double-cerebellar retractors are then placed for deeper and wider retraction and visualization.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The external surface of the skull base consists of the hard palate; posterior nasal apertures or choanae, separated from each other by the vomer; the sphenoid bone, with its greater and lesser wings, and the pterygoid processes; temporal bone, with the auditory groove and the mandibular fossa; and the occipital bone arranged around the foramen magnum. The major structures passing through the foramen magnum are the spinal cord, meninges, anterior and posterior spinal arteries, vertebral arteries, and spinal accessory nerve. The cranium articulates with the vertebral column by means of occipital condyles, located on the lateral parts of the occipital bone. The jugular foramen is located between the occipital bone and the petrous temporal bone—the internal jugular vein and cranial nerves IX-XI emerge through this foramen. The internal carotid artery enters the cranium through the carotid canal just anterior to the jugular foramen.
Neurosurgical trauma from E-Scooter usage: a review of early case series in London and a review of the literature
Published in British Journal of Neurosurgery, 2022
Sami Rashed, Anna Vassiliou, James Barber
In terms of cranial trauma, head injuries were cited as the most common site of injury in multiple studies and documented in 38.8% of all ED presentations. Of these the most commonly cited were minor head injuries (closed head injuries, without skull fracture or intracerebral haemorrhage (ICH)) in 53% (n = 8). Concussions were cited in 36.1% of head injuries (n = 12). Traumatic brain injury (TBI) was seen in 22.7% of head injury presentations (n = 6). ICH made up 15.2% of head injuries (n = 18). Of intracerebral bleeds, 34.4% were IPH (n = 2), 38.3% were tSAH (n = 7), 23.6% were aSDH (n = 6) and 9.2% were extradural haemorrhages (EDH) (n = 2). Skull fractures were noted in an average of 14.3% of all head injuries (n = 10) with basal skull fractures ranging from 0.5 to 13% and frontal sinus fractures ranging from 2.7 to 15.8% of all head injuries. Temporal and occipital bone fractures are also cited in the literature. Craniofacial fractures made up the majority of remaining fractures in the literature. Two articles compared the incidence of head injury between E-scooter riders and non-riders.8,11 Head injury was present in 21.4–40% of E-scooter riders and 11-38% of non-riders. In these studies, ICH was seen in 4.2–5.4% for E-scooter riders whereas no ICH and only minor head injuries were seen in non-riders.
Spontaneous morphological remodelling of the O-C1 joint after posterior fusion for occipitocervical dislocation
Published in International Journal of Neuroscience, 2022
Chizuo Iwai, Kazunari Fushimi, Satoshi Nozawa, Naofumi Mitsuishi, Hiroyasu Ogawa, Masato Maeda, Norishige Kuramitsu, Haruhiko Akiyama
Emergency halo-vest fixation with gentle manual reduction was performed. However, her dislocation of the O-C1 joint persisted under halo fixation. A scheduled spinal fusion was performed several days after the injury. When we released the connection of the halo ring in the supine position, her craniocervical junction was clearly unstable, and her head was whipping around (like figure skaters do), indicating severe instability of the O-C1 joint. She was gently turned into the prone position on the operation table, with stiffly kept under halo-vest fixation. Posterior reduction and spinal fusion from the occipital bone to the C2 (O-C2 fusion) were performed. Surgery was successful, without any intraoperative complications. However, complete reduction of the O-C1 joint was not achieved owing to severe instability at the O-C1 joint; hence, maintaining proper anatomical position was not possible. Final alignment was decided according to rod contour. Abundant autologous iliac crest bone and an allograft were placed in the posterior gap between the occipital bone and the lamina of the C2.
Posterior Fossa Decompression and superficial durotomy rather than complete durotomy and duraplasty in the management of Chiari 1
Published in Neurological Research, 2021
Adem Aslan, Usame Rakip, Mehmet Gazi Boyacı, Serhat Yildizhan, Serhat Kormaz, Emre Atay, Necmettin Coban
Ethics committee approval dated Ethics committee approval dated 05.06.2020 and numbered 2020/262 was obtained from the Local Ethics Committee of Afyonkarahisar Health Sciences University for the study and the patients provided informed consent………. Fifty-four patients with the diagnosis of CM who applied to the Department of Neurosurgery of Local Ethics Committee of Afyonkarahisar Health Sciences……… University to receive surgery for their condition between January 2012 and June 2019 and completed a minimum one-year follow-up were included in the study. The patients were divided into two groups according to the surgical technique performed. Group 1 included 10 patients who underwent classical posterior fossa decompression and duraplasty, and Group 2 included 44 patients who underwent minimally invasive surgery. Pre- and postoperative clinical signs and symptoms of all patients included in the study were recorded. At the same time, pre- and postoperative computed tomography (CT) and magnetic resonance (MRI) imaging was performed, and morphometric measurements were calculated. These were herniation size, craniocervical angle, the subarachnoid distance at the level of the cerebellum and foramen magnum, hydrocephalus index, and syringomyelia if accompanying CM were measured on CT and MRI (Figure 1). In addition to these measurements, the joining angle of the occipital bone (planum nuchae) from the linea nuchae inferior to the foramen magnum was examined.