DOCSLIB.ORG

Cerebrospinal Fluid Research Biomed Central

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cerebrospinal Fluid Research Biomed Central Cerebrospinal Fluid Research BioMed Central Research Open Access Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent Raymond F Sekula Jr*1, Peter J Jannetta1, Kenneth F Casey1, Edward M Marchan1, L Kathleen Sekula2 and Christine S McCrady2 Address: 1Department of Neurological Surgery, Center for Cranial Nerve Disorders, Allegheny Neuroscience Institute, 420 East North Avenue, Suite 302, Pittsburgh, PA, 15212-4746, USA and 2Graduate School of Forensic Nursing, Duquesne University, 600 Forbes Avenue, 524 Fisher Hall, Pittsburgh, PA, 15282, USA Email: Raymond F Sekula* - [email protected]; Peter J Jannetta - [email protected]; Kenneth F Casey - [email protected]; Edward M Marchan - [email protected]; L Kathleen Sekula - [email protected]; Christine S McCrady - [email protected] * Corresponding author Published: 18 December 2005 Received: 26 June 2005 Accepted: 18 December 2005 Cerebrospinal Fluid Research 2005, 2:11 doi:10.1186/1743-8454-2-11 This article is available from: http://www.cerebrospinalfluidresearch.com/content/2/1/11 © 2005 Sekula et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Chiari I malformation (CMI) is diagnosed by rigid radiographic criteria along with appropriate clinical symptomatology. The aim of this study was to investigate the dimensions of the posterior cranial fossa in patients without significant tonsillar descent but with symptoms comparable to CMI. Methods: Twenty-two patients with signs and symptoms comparable to CMI but without accepted radiographic criteria of tonsillar descent > 3–5 mm were referred to our clinic for evaluation. A history and physical examination were performed on all patients. In reviewing their MRI scans, nine morphometric measurements were recorded. The measurements were compared to measurements from a cohort of twenty-five individuals with cranial neuralgias from our practice. Results: For patients with Chiari-like symptomatology, the following statistically significant abnormalities were identified: reduced length of the clivus, reduced length of basisphenoid, reduced length of basiocciput, and increased angle of the tentorium. Multiple morphometric studies have demonstrated similar findings in CMI. Conclusion: The current classification of CMI is likely too restrictive. Preliminary morphologic data suggests that a subgroup of patients exists with tonsillar descent less than 3 mm below the foramen magnum but with congenitally hypoplastic posterior fossa causing symptomatology consistent with CMI. Background question whether the radiographic criterion of degree of The diagnosis of Chiari I malformation (CMI) is made by tonsillar ectopia, albeit useful, may be too restrictive in radiographic and clinical criteria. Criteria include tonsillar CMI. A substantial number of patients may be excluded descent 3–5 mm or more below the foramen magnum by the current radiographic criteria of CMI [1,2]. and compatible symptomatology. Recognized experts in the area of the craniovertebral junction have begun to Page 1 of 7 (page number not for citation purposes) Cerebrospinal Fluid Research 2005, 2:11 http://www.cerebrospinalfluidresearch.com/content/2/1/11 AmmFigure T2-weighted 1 sagittal MRI scan, from a patient with Chiari-like symptomatology, demonstrating tonsillar herniation less than 3 A T2-weighted sagittal MRI scan, from a patient with Chiari-like symptomatology, demonstrating tonsillar herniation less than 3 mm. The cisterna magna is completely obliterated by the thickened posterior rim of the foramen magnum. Meniscus sign (white arrow) is present at the inferior pole of the cerebellar tonsils consistent with a CSF block. Page 2 of 7 (page number not for citation purposes) Cerebrospinal Fluid Research 2005, 2:11 http://www.cerebrospinalfluidresearch.com/content/2/1/11 Table 1: Patient characteristics and signs consistent with Chiari I malformation but lack- ing the established radiographic criteria, most notably Chiari-like Group Control Group tonsillar descent below the foramen magnum of 3–5 mm. Number of Patients 22 25 No patient had undergone surgical treatment for CMI or Ageb 48 (17–65) 51 (34–68) syringomyelia. All patients underwent a complete physi- Male to female ratio 8:14 9:16 cal and neurological examination. As a control group, we Duration of symptomsb 7.4 (3–15) N/A studied the preoperative MRI films of 25 consecutive indi- viduals who had successfully undergone microvascular b Mean (range) in years decompression for trigeminal neuralgia with no evidence N/A, not applicable of hindbrain compression or syringomyelia. These In our Center for Cranial Nerve Disorders, we have evalu- patients were selected as controls and presumed to reflect ated a number of patients who present with clinical symp- the normal population. Table 1 summarizes the character- tomatology consistent with CMI without the established istics of the patients with Chiari-like symptomatology and radiographic evidence of tonsillar descent below the the control patients. Both groups consented to participate foramen magnum of 3–5 mm. Multiple morphometric in this study. This study was conducted in accordance with studies have established that the underlying defect in the Declaration of Helsinki and approved by our Internal patients with CMI is overcrowding of a normally devel- Review Board (RC-4039). oped hindbrain in a 'too small' or hypoplastic posterior cranial fossa [1-10]. Because many of our patients with Baseline assessments Chiari-like symptomatology have compression of the CSF A symptom checklist was prospectively developed which cisterns posterior and lateral to the cerebellum by subjec- incorporated the most common findings in CMI patients tive interpretation (Figure 1), we looked for evidence of [1]. Each patient was asked to complete the checklist prior posterior cranial fossa hypoplasia in these patients. to examination. A physician assistant and nurse then reviewed the checklist with each patient. A portion of this The aim of this study was to investigate the dimensions of checklist is summarized in Table 2. In addition, each the posterior cranial fossa in a subset of patients without patient was administered the Minnesota Multiphasic Per- significant tonsillar descent (<3 mm) but symptoms com- sonality Inventory-2 Test (MMPI 2). This test is the most parable to CMI. We quantitatively compared multiple commonly used standardized test of emotional status, structures in the posterior fossa with normal controls and can assist with the diagnosis of mental disorders from our practice to assess any recognizable differences. according to the Diagnostic and Statistical Manual of We were then able to compare our measurements with the Mental Disorders IV (DSM-IV). All study patients scored published normative data and the data from the CMI pop- in the normal range for their age group on the MMPI 2. ulation. An MRI (1.5T) of the craniocervical junction was obtained Methods from each patient prior to arrival in Pittsburgh. We Patients reviewed the images and confirmed tonsillar descent less This study prospectively analyzed 22 adults (15 female than 3 mm and the absence of syringomyelia. Patients and 7 male) ranging in age from 17 to 65 years between with basilar invagination and /or platybasia were February 2001 and June 2002. The patients were referred excluded from the study. to our Center for Cranial Nerve Disorders with symptoms Morphological features of the posterior cranial fossa Table 2: The number and percentage of patients in the Chiari- The morphological characteristics of the posterior cranial like group with symptoms and signs of Chiari I malformation fossa were compiled using midline sagittal T1-weighted MRI scans (Figure 2). A physician and physician assistant Symptoms and Signs Chiari-like Percent blinded to the patients' diagnoses determined the meas- Group (N = 22) urements. A composite of nine measurements from three recently published morphometric studies [1,10,11] were Headache 16 73 selected to evaluate the posterior fossa: 1) length of the cli- Cervicalgia 9 41 vus (d+e) from the basion to the top of the dorsum sellae, Dysphagia 11 50 2) length of the basiocciput (e) as determined from the Absent/impaired gag reflex 11 50 distance of the basioccipital sychondrosis to the basion, Lower extremity parasthesia/hyperesthesia 12 55 3) length of the basisphenoid (d) as determined from the Dizziness 13 59 distance of the basioccipital synchondrosis to the top of Retro-orbital pressure or pain 9 41 Tinnitus 9 41 the dorsum sellae, 4) length of the supraocciput (IOP to OP) between the internal occipital protuberance and the Page 3 of 7 (page number not for citation purposes) Cerebrospinal Fluid Research 2005, 2:11 http://www.cerebrospinalfluidresearch.com/content/2/1/11 AbrainstemFigure T1-weighted 2 and thesagittal cerebellum MR image from a control subject, showing the midline structures of the posterior cranial fossa and the A T1-weighted sagittal MR image from a control subject, showing the midline structures of the posterior cranial fossa and the brainstem and the cerebellum. d + e = length of clivus; S = sphenooccipital synchondrosis; d = length of basisphenoid between the top of the dorsum sellae and the sphenooccipital synchondrosis
Load more

Recommended publications
  • Entrapment Neuropathy of the Central Nervous System. Part II. Cranial
    Entrapment neuropathy of the Cranial nerves central nervous system. Part II. Cranial nerves 1-IV, VI-VIII, XII HAROLD I. MAGOUN, D.O., F.A.A.O. Denver, Colorado This article, the second in a series, significance because of possible embarrassment considers specific examples of by adjacent structures in that area. The same entrapment neuropathy. It discusses entrapment can occur en route to their desti- nation. sources of malfunction of the olfactory nerves ranging from the The first cranial nerve relatively rare anosmia to the common The olfactory nerves (I) arise from the nasal chronic nasal drip. The frequency of mucosa and send about twenty central proces- ocular defects in the population today ses through the cribriform plate of the ethmoid bone to the inferior surface of the olfactory attests to the vulnerability of the optic bulb. They are concerned only with the sense nerves. Certain areas traversed by of smell. Many normal people have difficulty in each oculomotor nerve are pointed out identifying definite odors although they can as potential trouble spots. It is seen perceive them. This is not of real concern. The how the trochlear nerves are subject total loss of smell, or anosmia, is the significant to tension, pressure, or stress from abnormality. It may be due to a considerable variety of causes from arteriosclerosis to tu- trauma to various bony components morous growths but there is another cause of the skull. Finally, structural which is not usually considered. influences on the abducens, facial, The cribriform plate fits within the ethmoid acoustic, and hypoglossal nerves notch between the orbital plates of the frontal are explored.
    [Show full text]
  • Morfofunctional Structure of the Skull
    N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V.
    [Show full text]
  • MBB: Head & Neck Anatomy
    MBB: Head & Neck Anatomy Skull Osteology • This is a comprehensive guide of all the skull features you must know by the practical exam. • Many of these structures will be presented multiple times during upcoming labs. • This PowerPoint Handout is the resource you will use during lab when you have access to skulls. Mind, Brain & Behavior 2021 Osteology of the Skull Slide Title Slide Number Slide Title Slide Number Ethmoid Slide 3 Paranasal Sinuses Slide 19 Vomer, Nasal Bone, and Inferior Turbinate (Concha) Slide4 Paranasal Sinus Imaging Slide 20 Lacrimal and Palatine Bones Slide 5 Paranasal Sinus Imaging (Sagittal Section) Slide 21 Zygomatic Bone Slide 6 Skull Sutures Slide 22 Frontal Bone Slide 7 Foramen RevieW Slide 23 Mandible Slide 8 Skull Subdivisions Slide 24 Maxilla Slide 9 Sphenoid Bone Slide 10 Skull Subdivisions: Viscerocranium Slide 25 Temporal Bone Slide 11 Skull Subdivisions: Neurocranium Slide 26 Temporal Bone (Continued) Slide 12 Cranial Base: Cranial Fossae Slide 27 Temporal Bone (Middle Ear Cavity and Facial Canal) Slide 13 Skull Development: Intramembranous vs Endochondral Slide 28 Occipital Bone Slide 14 Ossification Structures/Spaces Formed by More Than One Bone Slide 15 Intramembranous Ossification: Fontanelles Slide 29 Structures/Apertures Formed by More Than One Bone Slide 16 Intramembranous Ossification: Craniosynostosis Slide 30 Nasal Septum Slide 17 Endochondral Ossification Slide 31 Infratemporal Fossa & Pterygopalatine Fossa Slide 18 Achondroplasia and Skull Growth Slide 32 Ethmoid • Cribriform plate/foramina
    [Show full text]
  • A Bony Canal in the Basilar Part of Occipital Bone
    eISSN 1308-4038 International Journal of Anatomical Variations (2010) 3: 112–113 Case Report A bony canal in the basilar part of occipital bone Published online August 9th, 2010 © http://www.ijav.org Navneet Kumar CHAUHAN ABSTRACT Jyoti CHOPRA Clivus is a gradual slopping process behind the dorsum sellae that runs obliquely backwards. An unusual 6 mm Anita RANI long and 1 mm wide bony canal was observed on the lower one third of clivus in an adult human dry skull. The Archana RANI internal end of the canal was opening in the midline. The canal was directed downwards, forwards and laterally. Ajay Kumar SRIVASTAVA The external opening was present antero-lateral to the pharyngeal tubercle on the left side. Presence of any canal in the clivus is a rare occurrence. There could be two possible explanations for its formation. It could be because of presence of a connecting vein or it might have contained the remnant of notochord. We believe that in the present case more likely a venous communication existed between the basilar Department of Anatomy, Chhatrapati Shahuji Maharaj Medical University, Lucknow, and pharyngeal venous plexuses, which led to the formation of this bony canal. The canal of the clivus might INDIA. interfere with the neurosurgical operations in the clival region or can be confused for a fracture of clivus. © IJAV. 2010; 3: 112–113. Dr. Navneet Kumar Chauhan Associate Professor Department of Anatomy Chhatrapati Shahuji Maharaj Medical University (Upgraded King George’s Medical College) Lucknow, 226003, U.P, INDIA. +91 941 5083580 [email protected] Received December 19th, 2009; accepted July 11th, 2010 Key words [clivus] [clival canal] [occipital bone] [notochord remnant] Introduction Discussion The clivus (Latin: slope) is a curved sloppy surface Presence of any canal in the clivus is a rare occurrence.
    [Show full text]
  • Pathogenesis of Chiari Malformation: a Morphometric Study of the Posterior Cranial Fossa
    Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa Misao Nishikawa, M.D., Hiroaki Sakamoto, M.D., Akira Hakuba, M.D., Naruhiko Nakanishi, M.D., and Yuichi Inoue, M.D. Departments of Neurosurgery and Radiology, Osaka City University Medical School, Osaka, Japan To investigate overcrowding in the posterior cranial fossa as the pathogenesis of adult-type Chiari malformation, the authors studied the morphology of the brainstem and cerebellum within the posterior cranial fossa (neural structures consisting of the midbrain, pons, cerebellum, and medulla oblongata) as well as the base of the skull while taking into consideration their embryological development. Thirty patients with Chiari malformation and 50 normal control subjects were prospectively studied using neuroimaging. To estimate overcrowding, the authors used a "volume ratio" in which volume of the posterior fossa brain (consisting of the midbrain, pons, cerebellum, and medulla oblongata within the posterior cranial fossa) was placed in a ratio with the volume of the posterior fossa cranium encircled by bony and tentorial structures. Compared to the control group, in the Chiari group there was a significantly larger volume ratio, the two occipital enchondral parts (the exocciput and supraocciput) were significantly smaller, and the tentorium was pronouncedly steeper. There was no significant difference in the posterior fossa brain volume or in the axial lengths of the hindbrain (the brainstem and cerebellum). In six patients with basilar invagination the medulla oblongata was herniated, all three occipital enchondral parts (the basiocciput, exocciput, and supraocciput) were significantly smaller than in the control group, and the volume ratio was significantly larger than that in the Chiari group without basilar invagination.
    [Show full text]
  • Effects of Morphological Changes in Sella Turcica: a Review
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 03, 2020 1662 EFFECTS OF MORPHOLOGICAL CHANGES IN SELLA TURCICA: A REVIEW Chandrakala B1, Govindarajan Sumathy2, Bhaskaran Sathyapriya*, Pavishwarya P3, Sweta Jain3 1. Senior Lecturer, Department of Anatomy, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Chennai. 2. Professor and Head, Department of Anatomy, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Chennai. 3. Graduate student, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research *Professor, Department of Anatomy, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Chennai. Corresponding author: Dr. Bhaskaran Sathyapriya Professor, Department of Anatomy, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Chennai. ABSTRACT Sella turcica is a saddle shaped bony structure present on the sphenoid bone. The pituitary gland is seated at the inferior aspect of the sella turcica, called hypophyseal fossa. Sella turcica serves as a cephalometric landmark, that being said any morphological changes can affect the overall craniometry of the individual as well as alter the function of the structures it lodges. The following review emphasis on the possible morphological changes of sella turcica and its effects on the individual. Keywords: Pituitary gland, morphology, bridge, foramen, bone. 1662 European Journal of Molecular
    [Show full text]
  • Pterional Craniotomy Via a Transcavernous Approach for the Treatment of Low-Lying Distal Basilar Artery Aneurysms
    Pterional craniotomy via a transcavernous approach for the treatment of low-lying distal basilar artery aneurysms Stephen L. Nutik, M.D., Ph.D. Department of Neurosurgery, Kaiser Foundation Hospital, Redwood City, California Object. The author describes a surgical procedure in which pterional craniotomy is performed via a transcavernous approach to treat low-lying distal basilar artery (BA) aneurysms. This intradural procedure is compared with the extradural procedure described by Dolenc, et al. Methods. The addition of a transcavernous exposure to the standard pterional intradural transsylvian approach allows a lower exposure of the distal BA behind the dorsum sellae. The technical steps involved in this procedure are as follows: 1) removal of the anterior clinoid process; 2) entry into the cavernous sinus medial to the third nerve; 3) packing of the venous channels of the cavernous sinus lying between the carotid artery and the pituitary gland to open this space; 4) removal of the posterior clinoid process and the portion of the dorsum sellae that is exposed from within the cavernous sinus; and 5) removal of the exposed dura mater to obtain additional exposure of the perimesencephalic cistern. Eight cases of aneurysms of the distal BA are presented to illustrate how this approach can help in their surgical treatment. Conclusions. Using the standard pterional approach, these distal BA aneurysms were found to be either too low relative to the posterior clinoid process for adequate exposure or there was insufficient room for temporary clipping of the BA proximal to the lesion. The addition of a transcavernous exposure eliminated these technical problems and aneurysm clipping could be accomplished in each case.
    [Show full text]
  • Microsurgical Anatomy of the Dural Arteries
    ANATOMIC REPORT MICROSURGICAL ANATOMY OF THE DURAL ARTERIES Carolina Martins, M.D. OBJECTIVE: The objective was to examine the microsurgical anatomy basic to the Department of Neurological microsurgical and endovascular management of lesions involving the dural arteries. Surgery, University of Florida, Gainesville, Florida METHODS: Adult cadaveric heads and skulls were examined using the magnification provided by the surgical microscope to define the origin, course, and distribution of Alexandre Yasuda, M.D. the individual dural arteries. Department of Neurological RESULTS: The pattern of arterial supply of the dura covering the cranial base is more Surgery, University of Florida, complex than over the cerebral convexity. The internal carotid system supplies the Gainesville, Florida midline dura of the anterior and middle fossae and the anterior limit of the posterior Alvaro Campero, M.D. fossa; the external carotid system supplies the lateral segment of the three cranial Department of Neurological fossae; and the vertebrobasilar system supplies the midline structures of the posterior Surgery, University of Florida, fossa and the area of the foramen magnum. Dural territories often have overlapping Gainesville, Florida supply from several sources. Areas supplied from several overlapping sources are the parasellar dura, tentorium, and falx. The tentorium and falx also receive a contribution Arthur J. Ulm, M.D. from the cerebral arteries, making these structures an anastomotic pathway between Department of Neurological Surgery, University of Florida, the dural and parenchymal arteries. A reciprocal relationship, in which the territories Gainesville, Florida of one artery expand if the adjacent arteries are small, is common. CONCLUSION: The carotid and vertebrobasilar arterial systems give rise to multiple Necmettin Tanriover, M.D.
    [Show full text]
  • Craniumcranium
    CRANIUMCRANIUM THETHE SKULLSKULL R.R. DrugaDruga InstituteInstitute ofof Anatomy,Anatomy, 2nd2nd andand 1st1st MedicalMedical FacultyFaculty NEUROCRANIUMNEUROCRANIUM SPLANCHNOCRANIUMSPLANCHNOCRANIUM CRANIUM,CRANIUM, THETHE SKULLSKULL II MostMost highlyhighly modifiedmodified regionregion inin thethe axialaxial skeletonskeleton TheThe neurocraniumneurocranium –– developeddeveloped fromfrom aa seriesseries ofof cartilagescartilages ventralventral toto thethe brainbrain (base)(base) FromFrom mesenchymemesenchyme overover thethe domedome ofof thethe headhead (calvaria(calvaria oror calva)calva) CranialCranial cavitycavity SplanchnocraniumSplanchnocranium –– branchialbranchial apparatusapparatus (cartilaginous(cartilaginous elements)elements) havehave beenbeen replacedreplaced byby overlyingoverlying dermaldermal bonesbones BranchialBranchial apparatusapparatus TheThe mandibularmandibular regionregion andand thethe neckneck areare formedformed byby sixsix pairedpaired branchialbranchial archesarches (cart.(cart. barsbars supportingsupporting thethe gillgill apparatus).apparatus). InIn thethe tetrapodstetrapods branchialbranchial archesarches werewere modifiedmodified andand persistpersist inin thethe facialfacial (maxilla,(maxilla, mandibula)mandibula) andand neckneck skeletonskeleton (laryngeal(laryngeal cartilages)cartilages) Derivatives of cartilagines of the branchial arches 1st arch = Meckel cart., mandibula, malleus 2nd arch = Reichert cart., stapes, styloid proc.,stylohyoid lig. 3rd arch = hyoid bone 4th and 6th arch = laryngeal
    [Show full text]
  • Endoscopic Endonasal Surgery of the Midline Skull Base: Anatomical Study and Clinical Considerations
    Neurosurg Focus 19 (1):E2, 2005 Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations LUIGI M. CAVALLO, M.D., PH.D., ANDREA MESSINA, M.D., PAOLO CAPPABIANCA, M.D., FELICE ESPOSITO, M.D., ENRICO DE DIVITIIS, M.D., PAUL GARDNER, M.D., AND MANFRED TSCHABITSCHER, M.D. Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy; Microsurgical and Endoscopic Anatomy Study Group, University of Vienna, Austria; and Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Object. The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods. To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable.
    [Show full text]
  • Morphometric Measurements of the Cranium in Congenital Bilateral Blind Males and Females
    Morphometric measurements of the cranium in congenital bilateral blind males and females Rengin Kosif1*, Ocal Sırmatel2, Arzu Canan2 1Department of Anatomy, Faculty of Medicine, University of Abant Izzet Baysal, Gölköy, 14280, Bolu, Turkey. 2Department of Radiology, Faculty of Medicine, University of Abant Izzet Baysal, Gölköy, 14280, Bolu, Turkey. Abstract Cranium dimensions diff er according to racial, geopraphic, ethnic and nutritional factors. Th is study will shed light on the question: “Is there a diff erence in the cranial distances measured between congenital bilateral blind people and healthy individuals?” Nine anthropometric measures were performed on the brain MRI midsagittally obtained from male and female congenital bilateral blinds. Th e anthropometric measures taken included the glabella-opisthocranion, nasion-dorsum sellae, dorsum sellae- opisthocranion, nasion-basion, nasion-opisthion, basion-opisthion, prosthion-basion, basion-vertex and the clival angle. In addition, the supratentorial and infratentorial areas were calculated. Glabella-opisthocranion, nasion-dorsum sellae, nasion-basion, prosthion-basion and clival angle were found to be smaller in the congenital bilateral blind females compared to the healthy group, but these results were not statistically signifi cant. Whereas, other measures out of the basion-opisthion were found to be smaller in the congenital bilateral blind males than in the healthy subjects. Of these results, the distance between glabella-opisthocranion, nasion-dorsum sellae and nasion-basion was signifi cantly smaller compared to the measurements taken from the healthy male group. Th e infratentorial area was signifi cantly smaller in congenital blind male subjects and the supratentorial area was signifi cantly larger in congenital blind female subjects. Th is study has revealed that the cranium dimensions of congenital blind people are to diff erent from normal individuals.
    [Show full text]
  • European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses
    ISSN: 03000729 INTERN AT IO N A L R H I N CONTENT O L O G I C Official Journal of the European and International Societies Position paper Lund VJ, Stammberger H, Fokkens WJ, Beale T, Bernal-Sprekelsen M, Eloy P, Georgalas C, Ger- S O C I E Y stenberger C, Hellings PW, Herman P, Hosemann WG, Jankowski R, Jones N, Jorissen M, Leunig T A, Onerci M, Rimmer J, Rombaux P, Simmen D, Tomazic PV, Tschabitscher M, Welge-Luessen A. European Position Paper on the Anatomical Terminology of the Internal Nose and Parana- VOLUME 50 | SUPPLEMENT 24 | MARCH 2014 sal Sinuses. Rhinology. 2014 Suppl. 24: 1-34. European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses Lund VJ, Stammberger H, Fokkens WJ et al. 2014 Anatomical terminology cover JS.indd 1 27-02-14 23:03 European Position Paper on the Anatomical Terminology of the INTERN AT Internal Nose and Paranasal Sinuses IO N A L R H I N O L O G I C Official Journal of the European and International Rhinologic Societies S O C I E Y T Editor-in-Chief Address Prof V.J. Lund Journal Rhinology, c/o AMC, Mrs. J. Kosman / A2-234, PO Box 22 660, Prof W.J. Fokkens 1100 DD Amsterdam, the Netherlands. Tel: +31-20-566 4534 Associate Editor Fax: +31-20-566 9662 Prof P.W. Hellings E-mail: [email protected] Website: www.rhinologyjournal.com Managing Editor Dr. W.T.V. Germeraad Assistant Editor Dr. Ch. Georgalas Editorial Assistant (contact for manuscripts) Mrs J.
    [Show full text]