DOCSLIB.ORG

Management of Malignant Tumors of the Anterior Skull Base: Experience with 76 Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Malignant Tumors of the Anterior Skull Base: Experience with 76 Patients Neurosurg Focus 13 (4):Article 5, 2002, Click here to return to Table of Contents Management of malignant tumors of the anterior skull base: experience with 76 patients KETAN R. BULSARA, M.D., TAKANORI FUKUSHIMA, M.D., D.M.SC., AND ALLAN H. FRIEDMAN, M.D. Duke Division of Neurosurgery, Durham; and Carolina Neuroscience Institute, Raleigh, North Carolina As the management of anterior cranial fossa malignancies has undergone significant evolution, decreases in mor- bidity and mortality rates have occurred. In this article, the authors discuss the clinical presentation, neuroimaging find- ings, and management options for common anterior skull base malignancies. Also discussed are surgery-related indi- cations and principles. KEY WORDS • anterior skull base • transbasal • nasopharyngeal carcinoma • esthesioneuroblastoma • transfacial In 1941 Dandy described anterior craniofacial resection Anterior transfacial approaches were described as early of orbital tumors.20 Prior to this, Frazier27 championed re- as 1829 by Lizars. Modifications were described by Fer- moving orbital rims to gain improved surgical access. In gusson in 1842.9 In the 1920s, Portmann and Retrouvey 1943 Ray and McLean59 combined a transcranial and reported the midfacial degloving procedure.7 Casson and transfacial approach for resection of a retinoblastoma. The associates10 further modified this technique, which was first en bloc resection of an extensive paranasal sinus then popularized by Conley and Price16 and Price alone.55 malignancy was initially reported by Smith, et al.,71 in A subcranial approach obviating the need for the transfa- 1954 and subsequently by Ketcham, et al.,38 and Van Bu- cial approach was initially described by Raveh, et al.,58 in ren, et al.79 Although complete tumor resection had con- 1978 for the management of craniofacial fractures and siderable benefits, the toll was an 80% morbidity rate and subsequently performed for the management of anterior a 7% mortality rate.38,69 The major cause of morbidity was skull base tumors. intracranial contamination due to sinonasal tract commu- The management of malignant tumors of the anterior 64 nication. This complication was reduced when recon- skull base can be technically demanding and has been as- structive techniques involving pericranial grafts were in- sociated with high rates of morbidity and mortality. troduced in 1979 by Schramm, et al.,65 and modified later 37 Advances in neuroimaging leading to earlier diagnosis, a by Johns, et al. With improvements in surgical tech- better understanding of the anatomy, and collaboration niques, the morbidity rate decreased to less than 40% and 45,46 among experienced surgeons has led to significant pro- mortality to between 0 to 2%. gress in the management of these lesions. In 1960 Tessier, et al.,76 pioneered the transbasal ap- proach for the reduction of craniofacial abnormalities. Derome, alone,21 with Tessier,22 and with others23 used this MANAGEMENT OF ANTERIOR SKULL BASE approach for sphenoethmoidal tumor removal beginning MALIGANCIES in the 1970s. Modifications of this approach have led to increased anterior cranial fossa exposure requiring mini- Presentation and Neuroimaging Features mal brain retraction. Anterior fossa tumors can manifest as a number of dif- ferent symptoms, including nasal obstruction and conges- tion, epistaxis, rhinorrhea, hyposmia or anosmia, head- Abbreviations used in this paper: CA = carotid artery; CSF = cerebrospinal fluid; CT = computerized tomography; ICA = in- ache, seizure, and psychological changes. Paresthesias in ternal CA; MR = magnetic resonance; UCNT = undifferentiated the distribution of the V1 or V2 divisions of the trigemi- carcinoma of the nasopharyngeal type; WHO = World Health Or- nal nerve may occur. Invasion into the sella turcica can ganization. cause loss of endocrine function, or invasive pituitary tu- Neurosurg. Focus / Volume 13 / October, 2002 1 Unauthenticated | Downloaded 10/01/21 03:52 PM UTC K. R. Bulsara, T. Fukushima, and A. H. Friedman mors can be responsible for over production of cortico- tion with peaks in the second and sixth decades of life. steroids, growth hormone, or prolactin. Visual loss can be It occurs predominantly in males. It is divided into two uni- or bilateral. Associated ocular symptoms include dip- distinct histological entities: squamous cell carcinoma lopia, orbital pain, exophthalmos, and retroorbital head- and UCNT. The WHO classifies nasopharyngeal carcino- aches. Many of these tumors can be demonstrated on ma based on the degree of differentiation:67,70,81 Type I is nasopharyngeal examination. a keratinizing squamous cell carcinoma similar to that Diverse tumors can involve the anterior cranial fossa. found in the rest of the upper digestive tract; Type II is a Primary benign tumors with rare malignant potential in- nonkeratinizing epidermoid carcinoma; and Type III is clude meningiomas and pituitary adenomas. Primary ma- UCNT. Numerous staging schemes are present for maxil- lignant tumors include chordomas, chondrosarcomas, lary and ethmoid neoplasms; however, only the University osteogenic sarcomas, and invasive pituitary tumors. of Florida staging system can be applied to all parana- Malignant tumors with secondary involvement include sal neoplasms.50,52 In this classification system, T1 tumors carcinoma of the paranasal sinuses. Others include lym- are limited to a single site of origin such as a nasal wall phoma arising from the adenoids, minor salivary gland or ethmoids; T2 tumors extend to an adjacent sinus, or- neoplasms, ethmoid carcinoma, paragangliomas, olfactory bit, palate, nasopharynx, or pterygomaxillary sites; and neuroblastomas, mucoepidermoid carcinomas, and osteo- T3 tumors extend to or through the skull base. Resection sarcomas. Histologically benign tumors include angiofi- of T1 tumors is associated with the least morbidity and bromas and inverted papillomas. Metastases from renal, mortality breast, and lung carcinoma can also involve the anterior The UCNT differs from other head and neck squamous cranial fossa. Teratocarcinomas are rare in this region cell carcinomas by its histological features, epidemiologi- (Fig. 1). Lastly, paranasal sinus infections can extend into cal characteristics, and its relation with the Epstein–Barr the anterior skull base. virus. Of nasopharyngeal carcinomas, it is the more preva- Computerized tomography and MR imaging provide lent. It is endemic in Southeast Asia, parts of the Med- complementary information regarding skull base lesions. iterranean basin, North Africa, parts of the Caribbean and Whereas CT scanning is better at defining osseous anato- Alaska. A characteristic feature of the undifferentiated tu- my and calcifications, MR imaging is superior at demon- mor is massive lymphoid T-cell infiltration. strating the relationship of skull base masses to soft-tissue The UCNT is associated with the Epstein–Barr vir- structures such as cranial nerves, the CA, the jugular vein, us.35,75,78,80 Deletion of tumor suppressor genes such as p16 and the brain. In the case of parasellar masses, MR imag- or the activation of oncogenes such as bcl-2 may predis- ing is better in excluding CA aneurysms. pose individuals to the development of WHO Types II and Nasopharyngeal Carcinoma. Nasopharyngeal carcino- III carcinoma.47,48 Dietary factors such as salted fish high ma arises from the surface epithelium of the nasopharynx in volatile nitrosamines have also been implicated in and commonly metastasizes to the lymph nodes, with UCNT.82 some preference for those at the apex of the posterior cer- Squamous cell carcinoma (WHO Type I) is more com- vical triangle.18 As many as 82% of the tumors arise in the mon in the Western population. The use of tobacco and lateral wall of the nasopharynx in Rosenmüller fossa (pha- alcohol may play a role in the development of this well- ryngeal recess), 12% in the midline, and 6% in normal- differentiated tumor.13 It is rarely associated with the Ep- appearing mucosa.70 stein–Barr virus. Mutations of the p53 gene commonly Nasopharyngeal carcinoma has a bimodal age distribu- occur.26 Patients with nasopharyngeal carcinoma may present with variable nonspecific symptoms, the most common of which is painless posterior cervical adenopathy. Lateral pharyngeal node involvement may result in pain with ipsi- lateral neck rotation or ear pain. Unilateral conductive hearing loss resulting from serous effusions due to poor eustachian tube function commonly occurs. Nasal ob- struction occurs late in the course of the disease and pro- fuse epistaxis is rare. Dysphonia, difficulty swallowing, and diplopia may also occur. Physical examination may reveal maxillary nerve dysfunction. Extension of the tu- mor into the lateral pharynx results in ninth and 10th cra- nial nerve palsies. Proptosis and trismus are rarely associ- ated with these malignancies. Nasopharyngeal carcinoma is associated with bone de- struction demonstrated on CT scanning. Intense homoge- neous enhancement of the lesion is seen following con- trast administration. The lesion can invade the middle fossa either by erosion through the greater wing of the Fig. 1. Neuroimaging studies. Left: Pathological diagnosis sphenoid or extension through the foramen ovale. In ad- of this heterogeneously enhancing lesion was teratocarcinoma. vanced cases, the cancer can reach the clivus and violate Right: Two years following an extensive transbasal resection, no areas of the posterior fossa. Adenoid cystic carcinomas tumor recurrence is noted.
Load more

Recommended publications
  • Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations
    ORIGINAL RESEARCH INTERVENTIONAL Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations Z.-S. Shi, J. Ziegler, L. Feng, N.R. Gonzalez, S. Tateshima, R. Jahan, N.A. Martin, F. Vin˜uela, and G.R. Duckwiler ABSTRACT BACKGROUND AND PURPOSE: DAVFs rarely involve the sphenoid wings and middle cranial fossa. We characterize the angiographic findings, treatment, and outcome of DAVFs within the sphenoid wings. MATERIALS AND METHODS: We reviewed the clinical and radiologic data of 11 patients with DAVFs within the sphenoid wing that were treated with an endovascular or with a combined endovascular and surgical approach. RESULTS: Nine patients presented with ocular symptoms and 1 patient had a temporal parenchymal hematoma. Angiograms showed that 5 DAVFs were located on the lesser wing of sphenoid bone, whereas the other 6 were on the greater wing of the sphenoid bone. Multiple branches of the ICA and ECA supplied the lesions in 7 patients. Four patients had cortical venous reflux and 7 patients had varices. Eight patients were treated with transarterial embolization using liquid embolic agents, while 3 patients were treated with transvenous embo- lization with coils or in combination with Onyx. Surgical disconnection of the cortical veins was performed in 2 patients with incompletely occluded DAVFs. Anatomic cure was achieved in all patients. Eight patients had angiographic and clinical follow-up and none had recurrence of their lesions. CONCLUSIONS: DAVFs may occur within the dura of the sphenoid wings and may often have a presentation similar to cavernous sinus DAVFs, but because of potential associations with the cerebral venous system, may pose a risk for intracranial hemorrhage.
    [Show full text]
  • BONY FISHES 602 Bony Fishes
    click for previous page BONY FISHES 602 Bony Fishes GENERAL REMARKS by K.E. Carpenter, Old Dominion University, Virginia, USA ony fishes constitute the bulk, by far, of both the diversity and total landings of marine organisms encoun- Btered in fisheries of the Western Central Atlantic.They are found in all macrofaunal marine and estuarine habitats and exhibit a lavish array of adaptations to these environments. This extreme diversity of form and taxa presents an exceptional challenge for identification. There are 30 orders and 269 families of bony fishes presented in this guide, representing all families known from the area. Each order and family presents a unique suite of taxonomic problems and relevant characters. The purpose of this preliminary section on technical terms and guide to orders and families is to serve as an introduction and initial identification guide to this taxonomic diversity. It should also serve as a general reference for those features most commonly used in identification of bony fishes throughout the remaining volumes. However, I cannot begin to introduce the many facets of fish biology relevant to understanding the diversity of fishes in a few pages. For this, the reader is directed to one of the several general texts on fish biology such as the ones by Bond (1996), Moyle and Cech (1996), and Helfman et al.(1997) listed below. A general introduction to the fisheries of bony fishes in this region is given in the introduction to these volumes. Taxonomic details relevant to a specific family are explained under each of the appropriate family sections. The classification of bony fishes continues to transform as our knowledge of their evolutionary relationships improves.
    [Show full text]
  • Brain Sulci and Gyri: a Practical Anatomical Review
    Journal of Clinical Neuroscience 21 (2014) 2219–2225 Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn Neuroanatomical study Brain sulci and gyri: A practical anatomical review ⇑ Alvaro Campero a,b, , Pablo Ajler c, Juan Emmerich d, Ezequiel Goldschmidt c, Carolina Martins b, Albert Rhoton b a Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina b Department of Neurological Surgery, University of Florida, Gainesville, FL, USA c Department of Neurological Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina d Department of Anatomy, Universidad de la Plata, La Plata, Argentina article info abstract Article history: Despite technological advances, such as intraoperative MRI, intraoperative sensory and motor monitor- Received 26 December 2013 ing, and awake brain surgery, brain anatomy and its relationship with cranial landmarks still remains Accepted 23 February 2014 the basis of neurosurgery. Our objective is to describe the utility of anatomical knowledge of brain sulci and gyri in neurosurgery. This study was performed on 10 human adult cadaveric heads fixed in formalin and injected with colored silicone rubber. Additionally, using procedures done by the authors between Keywords: June 2006 and June 2011, we describe anatomical knowledge of brain sulci and gyri used to manage brain Anatomy lesions. Knowledge of the brain sulci and gyri can be used (a) to localize the craniotomy procedure, (b) to Brain recognize eloquent areas of the brain, and (c) to identify any given sulcus for access to deep areas of the Gyri Sulci brain. Despite technological advances, anatomical knowledge of brain sulci and gyri remains essential to Surgery perform brain surgery safely and effectively.
    [Show full text]
  • Distance Learning Program Anatomy of the Human Brain/Sheep Brain Dissection
    Distance Learning Program Anatomy of the Human Brain/Sheep Brain Dissection This guide is for middle and high school students participating in AIMS Anatomy of the Human Brain and Sheep Brain Dissections. Programs will be presented by an AIMS Anatomy Specialist. In this activity students will become more familiar with the anatomical structures of the human brain by observing, studying, and examining human specimens. The primary focus is on the anatomy, function, and pathology. Those students participating in Sheep Brain Dissections will have the opportunity to dissect and compare anatomical structures. At the end of this document, you will find anatomical diagrams, vocabulary review, and pre/post tests for your students. The following topics will be covered: 1. The neurons and supporting cells of the nervous system 2. Organization of the nervous system (the central and peripheral nervous systems) 4. Protective coverings of the brain 5. Brain Anatomy, including cerebral hemispheres, cerebellum and brain stem 6. Spinal Cord Anatomy 7. Cranial and spinal nerves Objectives: The student will be able to: 1. Define the selected terms associated with the human brain and spinal cord; 2. Identify the protective structures of the brain; 3. Identify the four lobes of the brain; 4. Explain the correlation between brain surface area, structure and brain function. 5. Discuss common neurological disorders and treatments. 6. Describe the effects of drug and alcohol on the brain. 7. Correctly label a diagram of the human brain National Science Education
    [Show full text]
  • Nasal Morphology and Its Correlation to Craniofacial Morphology in Lateral Cephalometric Analysis
    International Journal of Environmental Research and Public Health Article Nasal Morphology and Its Correlation to Craniofacial Morphology in Lateral Cephalometric Analysis Agnieszka Jankowska 1 , Joanna Janiszewska-Olszowska 2,* and Katarzyna Grocholewicz 2 1 Private Practice “Dental Clinic Jankowscy”, 68-200 Zary,˙ Poland; [email protected] 2 Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-91-466-1690 Abstract: Nose shape, size, and inclination influence facial appearance, but few studies concern the relationship between the nasal profile and craniofacial structures. The objective of this study was to analyze association of nasal cephalometric variables with skeletal structures, age, and sex. Cephalometric and nasal analysis was performed in 386 Polish orthodontic patients (aged 9–25 years). Student t-test and Mann–Whitney test were used to compare quantitative variables and Pearson’s or Spearman’s correlation coefficients—to find correlations. Soft tissue facial convexity angle corre- lates to Holdaway ratio, ANB (A-Nasion-B), and Wits appraisal. Nasal dorsum axis, nose length, nose depth (1) and nose depth (2), nose hump, lower dorsum convexity, and columella convexity increase with age. Nasal base angle, nasolabial angle, nasomental angle, soft tissue facial convex- ity and nasal bone angle decrease with age. Nasal base angle and nasomental angle are smaller in females. Thus, a relationship exists between nasal morphology and sagittal jaw configuration. Nasal parameters significantly change with age. Sexual dimorphism characterizes nasal bone angle Citation: Jankowska, A.; and nasomental angle. Janiszewska-Olszowska, J.; Grocholewicz, K. Nasal Morphology Keywords: nose; nose profile; cephalometry; orthodontics and Its Correlation to Craniofacial Morphology in Lateral Cephalometric Analysis.
    [Show full text]
  • Craniotomy for Anterior Cranial Fossa Meningiomas: Historical Overview
    Neurosurg Focus 36 (4):E14, 2014 ©AANS, 2014 Craniotomy for anterior cranial fossa meningiomas: historical overview SAUL F. MORALES-VALERO, M.D., JAMIE J. VAN GOMPEL, M.D., IOANNIS LOUMIOTIS, M.D., AND GIUSEPPE LANZINO, M.D. Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosur- gery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical proce- dures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas. (http://thejns.org/doi/abs/10.3171/2014.1.FOCUS13569) KEY WORDS • intracranial meningiomas • craniotomy • history • anterior cranial fossa ENINGIOMAS of the anterior cranial fossa represent has a few distinct clinical features. However, in practice, 12%–20% of all intracranial meningiomas.5,30 this group of tumors often represents a continuum.
    [Show full text]
  • Ardipithecus Ramidus and the Evolution of the Human Cranial Base
    Ardipithecus ramidus and the evolution of the human cranial base William H. Kimbela,1, Gen Suwab, Berhane Asfawc, Yoel Raka,d, and Tim D. Whitee,1 aInstitute of Human Origins and School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287; bThe University Museum, University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; cRift Valley Research Service, Addis Ababa, Ethiopia; dDepartment of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel; and eDepartment of Integrative Biology, Human Evolution Research Center, University of California, Berkeley, CA 94720 Contributed by Tim D. White, December 5, 2013 (sent for review October 14, 2013) The early Pliocene African hominoid Ardipithecus ramidus was di- We report here results of a metrical and morphological study agnosed as a having a unique phylogenetic relationship with the of the Ar. ramidus basicranium as another test of its hypothesized Australopithecus + Homo clade based on nonhoning canine teeth, phylogenetic affinity with Australopithecus and Homo. We ana- a foreshortened cranial base, and postcranial characters related to lyzed the length and breadth of the external cranial base and the facultative bipedality. However, pedal and pelvic traits indicating structural relationship between the petrous and tympanic elements substantial arboreality have raised arguments that this taxon may of the temporal bone in Ar. ramidus, Australopithecus (including instead be an example of parallel evolution of human-like traits Paranthropus of some authors), and mixed-sex samples of extant among apes around the time of the chimpanzee–human split. Here African hominoid (Gorilla gorilla, Pan troglodytes, Pan paniscus) we investigated the basicranial morphology of Ar.
    [Show full text]
  • Septation of the Sphenoid Sinus and Its Clinical Significance
    1793 International Journal of Collaborative Research on Internal Medicine & Public Health Septation of the Sphenoid Sinus and its Clinical Significance Eldan Kapur 1* , Adnan Kapidžić 2, Amela Kulenović 1, Lana Sarajlić 2, Adis Šahinović 2, Maida Šahinović 3 1 Department of anatomy, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina 2 Clinic for otorhinolaryngology, Clinical centre University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina 3 Department of histology and embriology, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina * Corresponding Author: Eldan Kapur, MD, PhD Department of anatomy, Medical faculty, University of Sarajevo, Bosnia and Herzegovina Email: [email protected] Phone: 033 66 55 49; 033 22 64 78 (ext. 136) Abstract Introduction: Sphenoid sinus is located in the body of sphenoid, closed with a thin plate of bone tissue that separates it from the important structures such as the optic nerve, optic chiasm, cavernous sinus, pituitary gland, and internal carotid artery. It is divided by one or more vertical septa that are often asymmetric. Because of its location and the relationships with important neurovascular and glandular structures, sphenoid sinus represents a great diagnostic and therapeutic challenge. Aim: The aim of this study was to assess the septation of the sphenoid sinus and relationship between the number and position of septa and internal carotid artery in the adult BH population. Participants and Methods: A retrospective study of the CT analysis of the paranasal sinuses in 200 patients (104 male, 96 female) were performed using Siemens Somatom Art with the following parameters: 130 mAs: 120 kV, Slice: 3 mm.
    [Show full text]
  • 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]
  • Pocket Atlas of Human Anatomy 4Th Edition
    I Pocket Atlas of Human Anatomy 4th edition Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. III Pocket Atlas of Human Anatomy Based on the International Nomenclature Heinz Feneis Wolfgang Dauber Professor Professor Formerly Institute of Anatomy Institute of Anatomy University of Tübingen University of Tübingen Tübingen, Germany Tübingen, Germany Fourth edition, fully revised 800 illustrations by Gerhard Spitzer Thieme Stuttgart · New York 2000 Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. IV Library of Congress Cataloging-in-Publication Data is available from the publisher. 1st German edition 1967 2nd Japanese edition 1983 7th German edition 1993 2nd German edition 1970 1st Dutch edition 1984 2nd Dutch edition 1993 1st Italian edition 1970 2nd Swedish edition 1984 2nd Greek edition 1994 3rd German edition 1972 2nd English edition 1985 3rd English edition 1994 1st Polish edition 1973 2nd Polish edition 1986 3rd Spanish edition 1994 4th German edition 1974 1st French edition 1986 3rd Danish edition 1995 1st Spanish edition 1974 2nd Polish edition 1986 1st Russian edition 1996 1st Japanese edition 1974 6th German edition 1988 2nd Czech edition 1996 1st Portuguese edition 1976 2nd Italian edition 1989 3rd Swedish edition 1996 1st English edition 1976 2nd Spanish edition 1989 2nd Turkish edition 1997 1st Danish edition 1977 1st Turkish edition 1990 8th German edition 1998 1st Swedish edition 1979 1st Greek edition 1991 1st Indonesian edition 1998 1st Czech edition 1981 1st Chinese edition 1991 1st Basque edition 1998 5th German edition 1982 1st Icelandic edition 1992 3rd Dutch edtion 1999 2nd Danish edition 1983 3rd Polish edition 1992 4th Spanish edition 2000 This book is an authorized and revised translation of the 8th German edition published and copy- righted 1998 by Georg Thieme Verlag, Stuttgart, Germany.
    [Show full text]
  • Morphological and Topographical Study of Wormian Bones in Cadaver Dry Skulls
    Original article Morphological and topographical study of Wormian bones in cadaver dry skulls Murlimanju, BV.*, Prabhu, LV., Ashraf, CM., Kumar, CG., Rai, R. and Maheshwari, C. Department of Anatomy, Manipal University, Centre for Basic Sciences, Kasturba Medical College, Mangalore, India *E-mail: [email protected] Abstract Introduction: The Wormian bones are formations associated with insufficient rate of suture closure and regarded as epigenetic and hypostotic traits. It was reported that there exists racial variability among the incidence of these bones. In the present study, the aims were to find the incidence of Wormian bones in Indian skulls and to analyze them topographically. Material and methods: The study included 78 human adult dry skulls of Indian population which were obtained from the neuroanatomy laboratory of our institution. They were macroscopically observed for the incidence and topographical distribution of the Wormian bones. Results: The Wormian bones were observed in 57 skulls (73.1%) of our series. Remaining 21 skulls (26.9%) didn’t show these variant bones. They were observed at the lambdoid suture in 56.4% cases (44 skulls; 14-bilateral; 18-right side; 12-left side), at the asterion in 17.9% (14 skulls; 3-bilateral; 2-right side; 9-left side), at the pterion in 11.5% (9 skulls; 4-right side; 5-left side), at the coronal suture in 1.3% (only one skull) and at the sagittal suture in 1.3% cases (only one skull). Conclusion: The current study observed Wormian bones in 73.1% of the cases from Indian population. This incidence rate is slightly higher compared to other reports and may be due to racial variations.
    [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]