Cranial Lesions Research Articles

Cranial thoracic myelopathies (T1-T6 vertebrae): Retrospective evaluation of the signalment, clinical presentation, and, presumptive or final diagnoses in 84 dogs.

The aim of the study was to describe the signalment, clinical presentation and presumptive or final diagnoses of dogs with cranial thoracic spinal cord lesions identified on advanced imaging. Retrospective evaluation of the databases of three veterinary specialty centres, between 2009 and 2021, was performed to identify dogs with a lesion affecting the cranial thoracic vertebral column (T1-T6 vertebrae) as the primary cause for presenting signs of myelopathy and/or spinal pain. Eighty-four dogs were included in the study, with the majority (n = 76) presenting with a progressive history of over 4-weeks' duration. On neurologic examination, most dogs were ambulatory (n = 64), and the most common neuroanatomic localisation was the T3-L3 spinal cord segments (n = 63). Twelve dogs (14%) showed a short-strided thoracic limb gait on clinical examination. The most common diagnosis was neoplasia (n = 33), followed by anomalies (n = 22, including vertebral body malformations in 14 dogs) and degenerative disorders (n = 16, with intervertebral disc protrusion diagnosed in 9 dogs). The most common vertebrae affected were T3 and T5. Most dogs with degenerative conditions showed asymmetric clinical signs, and the majority of dogs with neoplasia showed signs of spinal hyperaesthesia on examination. The findings of this study describe the clinical signs and presumptive or final diagnoses associated with lesions affecting the cranial thoracic spinal cord. When combined with the signalment and clinical history, this information can assist in both the recognition of and problem-based approach to these cases.

Region-of-interest intra-arc MV imaging to facilitate sub-mm positional accuracy with minimal imaging dose during treatment deliveries of small cranial lesions.

To automate the generation of region-of-interest (ROI) apertures for use with megavoltage imaging for online positional corrections during cranial stereotactic radiosurgery. Digitally reconstructed radiographs (DRRs) were created for a 3D-printed skull phantom at 5degree gantry angle increments for a three-arc beam arrangement. At each angle, 3000 random rectangular apertures were generated, and 100 shifts on a grid were applied to the anatomy within the frame. For all shifts, the mutual information (MI) between the shifted and unshifted DRR was calculated to derive an average MI gradient. The top 10% of apertures that minimized registration errors were overlaid and discretely thresholded to generate imaging plans. Imaging was acquired with the skull while implementing simulated patient motion on a linac. Control point-specific couch motions were derived to align the skull to its planned positioning. Apertures with a range of repositioning errors less than 0.1mm possessed a 42% larger average MI gradient when compared with apertures with a range greater than 1mm. Dose calculations with Monte Carlo exhibited an 84% reduction in the dose received by 50% of the skull with the 50% thresholded plan when compared to a constant 22×22cm2 imaging plan. For all different imaging plans (with and without motion), the calculated median 3D-errors with respect to the tracking of a metal-BB fiducial positioned at isocenter in the skull were sub-mm except for the 80% thresholded plan. Sub-mm positional errors are achievable with couch motions derived from control point-specific ROI imaging. Smaller apertures that conform to an anatomical ROI can be utilized to minimize the imaging dose incurred at the expense of larger errors.

Evaluation of the ability of the Brainlab Elements Cranial Distortion Correction algorithm to correct clinically relevant MRI distortions for cranial SRT.

Cranial stereotactic radiotherapy (SRT) requires highly accurate lesion delineation. However, MRI can have significant inherent geometric distortions. We investigated how well the Elements Cranial Distortion Correction algorithm of Brainlab (Munich, Germany) corrects the distortions in MR image-sets of aphantom and patients. Anon-distorted reference computed tomography image-set of aCIRS Model 603-GS (CIRS, Norfolk, VA, USA) phantom was acquired. Three-dimensional T1-weighted images were acquired with five MRI scanners and reconstructed with vendor-derived distortion correction. Some were reconstructed without correction to generate heavily distorted image-sets. All MR image-sets were corrected with the Brainlab algorithm relative to the computed tomography acquisition. CIRS Distortion Check software measured the distortion in each image-set. For all uncorrected and corrected image-sets, the control points that exceeded the 0.5-mm clinically relevant distortion threshold and the distortion maximum, mean, and standard deviation were recorded. Empirical cumulative distribution functions (eCDF) were plotted. Intraclass correlation coefficient (ICC) was calculated. The algorithm was evaluated with 10brain metastases using Dice similarity coefficients (DSC). The algorithm significantly reduced mean and standard deviation distortion in all image-sets. It reduced the maximum distortion in the heavily distorted image-sets from 2.072 to 1.059 mm and the control points with > 0.5-mm distortion fell from 50.2% to 4.0%. Before and especially after correction, the eCDFs of the four repeats were visually similar. ICC was 0.812 (excellent-good agreement). The algorithm increased the DSCs for all patients and image-sets. The Brainlab algorithm significantly and reproducibly ameliorated MRI distortion, even with heavily distorted images. Thus, it increases the accuracy of cranial SRT lesion delineation. After further testing, this tool may be suitable for SRT of small lesions.

Origins, phylogenetic relationships and host-parasite interactions of Troglotrematoidea since the cretaceous

In the current study, we raise the issue concerning origins and historical relationships of the trematodes from the families Troglotrematidae and Paragonimidae using phylogenetic analysis and molecular-clock method for estimating evolutionary rates. For the first time we provided 28S rRNA gene fragment (1764bp) for the type species Troglotrema acutum - zoonotic trematodes that cause cranial lesions (troglotremiasis) in mustelid and canid mammals of the Central Europe, Iberian Peninsula, and North-West Caucasus. Molecular genetic analysis revealed that T. acutum belongs to the monophyletic family Troglotrematidae sister with the family Paragonimidae. The family Troglotrematidae includes five genera: Nanophyetus, Troglotrema, Skrjabinophyetus, Nephrotrema, and Macroorchis; and the family Paragonimidae is monotypic including the only genus Paragonimus. We recover the superfamily Troglotrematoidea for these two families. Divergence of the common ancestor of the superfamily Troglotrematoidea (common troglotrematoid ancestor) likely occurred during the Cretaceous period of the Mesozoic Era and potentially originated in the Asiatic region. The lineage of the family Troglotrematidae is much closer to the common troglotrematoid ancestor than the species of the family Paragonimidae. The radiation time of the common troglotrematoid ancestor (126Ma, the Early Cretaceous), and formation of the families Troglotrematidae and Paragonimidae (96Ma and 73Ma respectively, the Late Cretaceous) corresponds to the time of settling in East Asia by many species of mammaliaforms (about 130-70Ma).

A rare case of calvarial tuberculosis from the Avar Age (8th century CE) cemetery of Kaba–Bitózug (Hajdú-Bihar county, Hungary) – Pathogenesis and differential diagnostic aspects

The aim of our paper is to present and discuss in detail the bony changes indicative of tuberculosis (TB) that were identified in a skeleton (KB67), unearthed from grave 67 of the 8th-century-CE cemetery of Kaba–Bitózug (Hungary). Furthermore, to provide the differential diagnoses of the observed alterations, with special attention to the cranial osteolytic lesions. During the macro- and micromorphological examinations of KB67, the skull revealed three small, well-circumscribed, punched-out osteolytic lesions accompanied by endocranial granular impressions, abnormal blood vessel impressions, periosteal appositions, and cortical erosion. The postcranial skeleton exhibited osteolytic lesions, cortical remodelling and erosion, and signs of hypervascularisation in the spine. Based on the differential diagnosis of the cranial osteolytic lesions and their co-occurrence with endocranial and vertebral bony changes indicative of TB, they most likely resulted from tuberculous involvement of the frontal and left parietal bones. The morphologically established diagnosis was confirmed by a PCR analysis that provided evidence for the presence of Mycobacterium tuberculosis DNA in KB67. KB67, the first reported archaeological case with calvarial TB from the present-day territory of Hungary, gives us a unique insight into the occurrence of a rare manifestation of TB in the Avar Age of the Great Plain.

Flipping the Anatomy Classroom with Clinical Cases and Teamwork at a Large Medical School

Students participating in active and collaborative learning understand concepts better, perform better in coursework, and have better attitudes toward teamwork. But, the rise of the digital age has had a negative effect on classroom engagement—a topic of international concern. At UT Southwestern Medical School, voluntary attendance at didactic anatomy sessions is at an all‐time low. Because we believe contact time with students is a valuable commodity, our objective is to develop an anatomy teaching approach that will improve student engagement and teamwork. As content hours are limited, time‐efficiency is essential to the approach we seek to develop. In a pilot study, we developed two face‐to‐face case‐based active learning sessions that were conducted within the time slots formerly scheduled for two face‐to‐face anatomy lecture sessions. Content formerly covered in these didactic sessions was converted into video format and offered on‐demand through our institution’s learning management system. Students were given instructions for pre‐session preparation (i.e., review of the videos and other course materials) several days prior to each session. Due to computer technology limitations in our cadaver lab, a virtual cadaver model (Complete Anatomy, 3D4Medical from Elsevier) was used in place of human cadavers for the two case‐based sessions. During the sessions, each laboratory dissection team of 6‐7 students worked at a table outfitted with a 42‐inch monitor capable of wireless connection to student laptops. The exercises focused on the anatomical basis for several clinical cases involving cranial nerve lesions (Session 1) and abdominal hernias (Session 2). Students were allotted 45 minutes for each mandatory session at the end of which teams were required to electronically submit a completed worksheet for credit. Following each session, students were invited to participate in a brief survey with two open‐ended questions that asked them to name one thing about the exercise they would change and one thing they would keep the same. Results of the surveys revealed that the two most commonly perceived benefits of the exercises were 1) application of anatomy to real cases (41 of 131 responses) and 2) opportunity to work in teams with other students (28 of 131 responses). The most commonly perceived challenge was insufficient time to work through the exercises as a team (95 of 131 responses). Student performance on exam questions directly related to the content of the pilot sessions was higher than in years prior to the pilot; however, this difference was not statistically significant in this high‐performing group of students. The survey results demonstrate that our students perceive value in teamwork and the opportunity to practice applying their theoretical knowledge to real‐world problems. The results also highlight the importance of carving out adequate time in the curriculum for these experiences. In the future, we aim to increase opportunities, outside of dissection and didactic sessions, for our students to practice these important, career‐relevant skills.

History of Skull Base Surgery

Skull base surgery is a surgical field that involves the cooperation of multiple surgical and medical specialties, including neurosurgery, head-neck surgery, plastic-reconstructive surgery, radiation oncology, as well as multiple medical supporting teams. This field has been developed with the collaborative efforts of these medical specialties, and its history can be divided into five phases: Beginning of surgery(Prior to 1940); Early skull base surgery driven by the ENT-HN surgery group(1940-70); Conventional skull base surgery development based on anatomical, physiological knowledge and microsurgical equipment and technique(1970-90); Reflection and consolidation of the surgical dimension(1995-2005); and Evolution of endoscopic and new skull base surgical techniques(2005-). Several topics and advancements have improved this surgical field, such as access to the cavernous sinus, petrosal-temporal bone, and foramen magnum; concepts of minimally invasive surgical techniques; advanced endoscopic instruments; knowledge of biological assessments; and development of surgical robotics. To achieve a safe and effective surgery for cases of difficult cranial base lesions, clinicians must understand the origin of the surgical field, the detailed anatomy and physiology of the skull base, and the basic microsurgical techniques.

Posterior fossa midline mass lesions clinicopathological study and management

Some of the most severe brain cancers are tumors in the posterior fossa. This is due to the small space available in the posterior fossa, as well as the possibility of essential brainstem nuclei involvement.: To assess the clinicopathological trends of posterior fossa midline mass lesions and to assess the outcome of the patients following surgery. This is a prospective study done in the patients admitted with posterior cranial fossa midline mass lesions who underwent surgical treatment in department of Neurosurgery. Patients were evaluated with regard Age, Sex, Clinical, Radiological and Pathological status at presentation, admission, during and after treatment. : Incidence rate of midline mass lesions in posterior fossa is 34.6%. Common age group of occurrence of posterior midline lesions is less than 10 years. Posterior fossa midline lesions are more common in males. The common sites of origin of posterior fossa midline lesions are the Vermis of Cerebellum and fourth ventricle. Most common pathological types are Medulloblastoma and Pilocytic astrocytoma. About 29.6% of posterior fossa midline lesions require CSF diversion prior to definitive surgery. Recurrence is noted in two cases one in brainstem astrocytoma and another in medulloblastoma. Mortality is noted in 18.5% cases of posterior fossa midline mass lesions. Prognosis is good in patients with total excision. This drives the surgeon to go for total excision.

A simulated comparison of lung tumor target verification using stereoscopic tomosynthesis or radiography.

Mobile lung tumors are increasingly being treated with ablative radiotherapy, for which precise motion management is essential. In-room stereoscopic radiography systems are able to guide ablative radiotherapy for stationary cranial lesions but not optimally for lung tumors unless fiducial markers are inserted. We propose augmenting stereoscopic radiographic systems with multiple small x-ray sources to provide the capability of imaging with stereoscopic, single frame tomosynthesis. In single frame tomosynthesis, nine x-ray sources are placed in a 3×3 configuration and energized simultaneously. The beams from these sources are collimated so that they converge on the tumor and then diverge to illuminate nine non-overlapping sectors on the detector. These nine sector images are averaged together and filtered to create the tomosynthesis effect. Single frame tomosynthesis is intended to be an alternative imaging mode for existing stereoscopic systems with a field of view that is three times smaller and a temporal resolution equal to the frame rate of the detector. We simulated stereoscopic tomosynthesis and radiography using Monte Carlo techniques on 60 patients with early-stage lung cancer from the NSCLC-Radiomics dataset. Two board-certified radiation oncologists reviewed these simulated images and rated them on a 4-point scale (1: tumor not visible; 2: tumor visible but inadequate for motion management; 3: tumor visible and adequate for motion management; 4: tumor visibility excellent). Each tumor was independently presented four times (two viewing angles from radiography and two viewing angles from tomosynthesis) in a blinded fashion over two reading sessions. The fraction of tumors that were rated as adequate or excellent for motion management (scores 3 or 4) from at least one viewing angle was 53% using radiography and 90% using tomosynthesis. From both viewing angles, the corresponding fractions were 7% for radiography and 48% for tomosynthesis. Readers agreed exactly on 62% of images and within 1 point on 98% of images. The acquisition technique was estimated to be 75 mAs at 120 kVp per treatment fraction assuming one verification image per breath, approximately one order of magnitude less than a standard dose cone beam CT. Stereoscopic tomosynthesis may provide a noninvasive, low dose, intrafraction motion verification technique for lung tumors treated by ablative radiotherapy. The system architecture is compatible with real-time video capture at 30 frames per second. Simulations suggest that most, but not all, lung tumors can be adequately visualized from at least one viewing angle.

Complications after stereotactic radiosurgery in patients with brain disorders

Objective: to analyze complications after stereotactic radiosurgery for various diseases performed using the Elekta Leksell Gamma Knife Perfexion.Materials and methods. This retrospective study of stereotactic radiosurgery outcomes included 3,148 patients with different brain lesions, including 1,621 individuals with metastases (51.5 %), 732 with meningiomas (23.3 %), 359 with neurinomas (11.4 %), 71 with arteriovenous malformations (2.3 %), 118 with cavernomas (3.7 %), 114 with neuroepithelial tumors (3.6 %), 46 with pituitary adenomas (1.5 %), 54 with functional diseases (1.7 %), and 33 with other diseases (1 %).The diagnosis was based on the results of neurological examination, magnetic resonance imaging, computed tomography, and positron emission tomography.The severity of radiation complications was evaluated using the Eastern Cooperative Oncology Group (ECOG) scale.Results. Among all patients who underwent stereotactic radiosurgery, 96 individuals developed 97 different complications. The most common complications included radionecrosis (n = 43) and perifocal edema (n = 38). Alopecia (n = 3) and increased frequency of epileptic seizures (n = 3) were less common. We observed very few specific complications, such as non-obstructive hydrocephalus (n = 3), cranial nerve lesions (n = 3), and endocrine disorders (n = 1). The total rate of radiation-induced complications was 3.08 %.Conclusion. Our findings suggest that stereotactic radiosurgery is a safe treatment for various brain diseases and is characterized by a low rate of postoperative complications. The incidence of postoperative complications in this study did not exceed that reported in Russian and foreign literature.

THE IMPORTANCE OF MAGNETIC RESONANCE SPECTROSCOPY IN THE DIFFERENTIAL DIAGNOSIS OF CRANIAL LESIONS AND ITS CORRELATION WITH PATHOLOGY RESULTS

OBJECTIVE: Preoperative diagnosis is very important in determining the treatment algorithm in cranial lesions. The aim of this study is to compare the results of magnetic resonance spectroscopy, which is one of the preoperative imaging methods, with the results of pathology and to reveal its effectiveness in diagnosis.MATERIAL AND METHODS: Thirty five patients who underwent preoperative magnetic resonance spectroscopy imaging among 75 patients who were operated for cranial lesions in our clinic between 2016 - 2019 were included in the study. N-acetyl aspartate, creatine, choline and lactate values were calculated as biochemical metabolites, and preoperative diagnoses made according to these values were compared with postoperative pathology results and discussed in the light of the literature.RESULTS: A total of 35 patients, 20 male and 15 female, were included in the study. The age range of the patients was between 18 - 82. As a result of magnetic resonance spectroscopy, 29 patients were diagnosed with high grade glial tumors. As a result of the postoperative evaluation, the magnetic resonance spectroscopy results of 27 patients were found to be compatible with the pathology results, while differences were observed in 8 patients. A significant increase in choline peak and choline / NAA ratio was noted in high-grade glial tumors.CONCLUSIONS: There is a high correlation between the preoperative evaluations obtained by magnetic resonance spectroscopy which is used in the differential diagnosis of cranial lesions, and the pathological diagnosis.

Clinical Characteristics and Follow-Up of Seizures in Children With Anti-NMDAR Encephalitis.

Objective: To analyze the seizure characteristics of children with anti-NMDAR encephalitis.Methods: This was a retrospective analysis of 50 children with anti-NMDAR encephalitis between July 1, 2013, and July 1, 2019.Results: Fifty children with anti-NMDAR encephalitis were included in this study, of which 34 (68.0%) had seizures. During the follow-up, three patients with anti-NMDAR encephalitis secondary to herpes simplex virus encephalitis had persistent seizures. The average duration of seizures in the remaining patients was 14.6 days (range 1–47 days). Compared to patients without seizures, those with seizures were more likely to experience consciousness disturbances (p = 0.008) and epileptic form discharge on electroencephalograms (p = 0.002). The Glasgow coma scale scores (p = 0.014), and Rankin scale scores (p = 0.019) were also different. The cranial MRI findings of children were reviewed, and clinical characteristics were compared between children without cranial lesions and those with lesions in the limbic system and neocortex. Compared to children in the non-lesion group, children with lesions in the limbic system and neocortex had a higher incidence of status epilepticus. Further, children in the limbic system and neocortical lesions groups were more likely to be taking anti-seizure medications (ASMs) and receive second-line drugs.Conclusion: Long-term oral ASMs are not recommended for most children with anti-NMDAR encephalitis. Children with involvement of the limbic system and neocortex are prone to status epilepticus, and sequelae of epilepsy may remain when the neocortex is involved.

An unsolved case in a culturally diverse community in Italy

The number of foreign citizens resident in Italy is approximately 5 million, making them the 8.7% of the resident population of the country. However, over the past 20 years, foreign citizens accounted for 24% of the total number of defendants involved in homicides, especially associated with robbery, disputes and assaults, generally connected to prostitution. Investigations of cases in the context of culturally diverse or minority communities can be particularly complex. This is due to the education, the cultural background and the cohesiveness of the community, alongside a negative view of law enforcement. These factors determine a relatively low resolution rate of these violent crimes in these communities.The investigation of the suspicious death of an Indian citizen living in Italy is presented in this paper. The body was discovered in a cattle shed, and despite the initial assumption of an accidental death, the cranial lesions were not consistent with the view that the death was caused by a kick by a cow. The results of a multidisciplinary analysis, including imaging, pathology, toxicology and veterinary forensics, were directed towards a homicide, with the manner of death ultimately filed as undetermined. During the course of the investigation, the collaboration between law enforcement and the community was thwart with difficulty, and as a consequence this case is currently unsolved. In order for law enforcement to continue to play a constructive and supportive role, it is imperative that every country invest in civil education of local population and of any ethnic groups, minorities and culturally diverse people.

Dysfunctions and anatomical relationships of cranial nerves in epidermoids of the cerebellopontine angle

To evaluate the correlation of neurological symptoms with anatomical relationships of cranial nerves, lesions and vessels in patients with epidermoids of the cerebellopontine angle. We analyzed neurological symptoms, magnetic resonance data, intraoperative findings and postoperative functional outcomes in 25 patients (14 females and 11 males aged 22-77 years) with epidermoids of the cerebellopontine angle. Cranial nerve dysfunctions were noted in 15 patients. Involvement of cochlear (n=9) and trigeminal (9 cases including 4 ones with sensory impairment and 5 patients with neuralgia) nerves was the most common. There were 10 patients with ataxia, hemiparesis and seizures without cranial nerve dysfunction. In 15 patients, epidermoids spread to supratentorial space and contralateral cerebellopontine angle. Lesion-induced brainstem compression was found in 22 cases. Cranial nerves and cerebellar arteries were partially or completely enclosed by lesion in all cases. Severe compression and dislocation of the nerve root entry/exit zone were found in all cases. One patient with trigeminal neuralgia had vascular compression of trigeminal nerve caused by superior cerebellar artery. Total resection was achieved in 16 patients. Small capsule remnants were left on vessels, nerves or brainstem in 9 patients. Postoperative complete or partial restoration of cranial nerve functions was noted in 11 cases. Deterioration of preoperative neurological deficit in 4 patients and postoperative neurological symptoms de novo in 3 patients were temporary. Cranial nerve dysfunctions are caused by compression of the nerve root entry/exit zones by epidermoids of the cerebellopontine angle. Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression. Vascular decompression should be performed in patients with trigeminal neuralgia.

L1 cell adhesion molecule high expression is associated with poor prognosis in surgically resected brain metastases from lung adenocarcinoma

ObjectivesAccurate prognosis assessment across the heterogeneous population of brain metastases is very important, which may facilitate clinical decision-making and appropriate stratification of future clinical trials. Previous studies have shown the L1 Cell Adhesion Molecule (L1CAM) is potentially involved in human malignancies of multiple different samples and unfavorable survival. However, no data of L1CAM are available for the brain metastases from lung adenocarcinoma, especially for the one with neurosurgical resection. MethodThe authors investigated the L1CAM expression in cranial metastatic lesions for patients with brain metastases from lung adenocarcinoma after neurosurgical resection using tissue microarrays that were obtained from the Department of Neurosurgery at the Cancer Hospital of the Chinese Academy of Medical Sciences. Furthermore, the relationship between L1CAM expression and clinic-pathological parameters, including overall survival time, was analyzed to assess the prognostic value of L1CAM. ResultsL1CAM high expression was found in 62.30% of brain metastases from lung adenocarcinoma and significantly correlated with brain metastasis number (p = 0.028) and Lung-molGPA score (p = 0.042). Moreover, L1CAM expression was an independent predictor of survival for brain metastases after neurosurgical resection in a multivariate analysis. Patients with L1CAM high expression had unfavorable overall survival time (p = 0.016). In addition, the multivariate analysis also showed age and extracranial transfer were also the independent prognostic factors for this type of patient with brain metastases. ConclusionsA subset of brain metastases from lung adenocarcinoma aberrantly expresses L1CAM. L1CAM is a novel independent prognostic factor for brain metastasis from lung adenocarcinoma after neurosurgical resection.

Warrior burial of the Late Bronze Age and Early Iron Age: The phenomenon of women warriors from the Jrapi cemetery (Shirak Province, Armenia)

AbstractStudy of the bone remains of two female warriors from Jrapi (Shirak Province, Armenia) burial ground (Burial 3) revealed a multiple array of traumatic lesions, which shed light on their daily activities, occupation, and warfare practice. Both women had compressive cranial lesions with the signs of healing. A bronze arrowhead once embedded in the soft tissues of the intercostal space was discovered as well as a canal in the lower epiphysis of the tibia probably left by the broken point of a bronze arrowhead. The women were likely horse riders and archers. The remains unearthed in Burial N 3 belonged to two females who seemed to live as professional warriors and were buried as individuals of rank. This tomb is the third burial discovered in Armenia that provides evidence on female warriors.

An anatomical model for studying cerebellar tonsillar herniation related to raised intracranial pressure

Brain herniation is one of the most feared complications of many neurological pathologies. However, current understanding of the mechanisms behind brain herniation syndromes is poor. By investigating the correlations between raised intracranial pressure (ICP) and herniation of the cerebellar tonsils, we hope to develop a model that can be used to study intracranial fluid dynamics and its effects on brain tissue. This will facilitate evaluation of patients with elevated ICP and development of novel treatments including surgical approaches for decompressing the posterior cranial fossa and upper cervical spine. A standard suboccipital surgical approach was used to expose the foramen magnum and observe movements of the cerebellar tonsils in fresh cadavers. A urinary Foley catheter balloon in the parietal extradural space was used to simulate a mass effect while ICP was monitored. The baseline anatomy differed widely among the cadaver specimens. However, and overall, we found that as ICP rises, the cerebellar tonsils descend through the foramen magnum at a rate of 0.3 mm per 1 mmHg increase in ICP. A mean descent of 6.2 mm was observed for a mean ICP increase of 17 mmHg. In this cadaveric study, we present a method and model for exploring brain herniation syndromes in the context of ICP changes. This could allow for further models to study the effects of other neuropathologies on the cerebellar tonsils, including posterior cranial fossa mass lesions and cerebellar hemorrhage.

A triple Cranial Vault lesion of Hyperostosis Frontalis Interna, Osteoma and Meningioma in a Cadaveric Skull

Cranial vault lesions are rare and may alter skull figure. Among them, osteomas are the most frequent entities found on burial remains. We present a skull (dry bone) which was unearth in the cemetery of Serres city in Northern Greece and was then donated to the Anatomy Department of the Democritus University of Thrace. The specimen presents a triple lesion and an odd figure, a reason which may explain why it was neglected for a long time period as an unwanted remain of a probably stigmatized person. Radiology (computed tomography) revealed a peculiar combination of a meningioma, an osteoma and a hyperostosis frontalis interna. KEY WORDS: Cranial Radiology, Meningioma en plaque, Hyperostosis.

Malignancy in three medieval Polish osteological collections

This paper presents the archaeological skeletal remains of four adult females presenting with cranial lesions typical of malignant neoplastic disease. The four cases were sourced from three medieval Polish skeletal assemblages: Milicz (12–13th century), Pawłów Trzebnicki (15–16th century), and Gródek nad Bugiem (13–15th century). The observed pathological skeletal changes were evaluated with a comprehensive macroscopic analysis of the skeleton, and radiography of the affected bones. The observed osteolytic lesions were largely limited to the crania and were multiple and varied in size; further internal lesions were revealed with radiography. Three cases were differentially diagnosed as highly consistent with metastatic carcinoma, and the fourth case was differentially diagnosed as typical of multiple myeloma. This report adds to the scant number of palaeopathological examples of malignant neoplasms in Poland and it discusses the possible impact of cancer on medieval lives, as well as possible factors in the occurrence of malignant neoplasms in medieval Poland.

MORPHOLOGICAL SPECTRUM OF INTRACRANIAL SPACE OCCUPYING LESION AT TERTIARY CARE HOSPITAL-A CLINICOPATHOLOGICAL STUDY

Introduction: The annual incidence of CNS tumors ranges from 10 to 17 per 1,00,000 persons for intracranial tumors, [1] the majority of these are primary tumors. An “Intra-cranial space occupying lesion” (ICSOL)is dened as a mass lesion in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inammatory or parasitic lesion, hematoma, or arterio-venous malformation.[3] Many non-neoplastic CNS lesions can clinically & radiologically simulate brain tumors. In such cases, histopathological [5] examination (HPE) can be helpful in differentiating between neoplastic and non-neoplastic etiologies. Aims and Objectives: This studywas undertaken to analyse theincidence and frequency of intracranial space occupying lesions, age and sex wise distribution, associated clinical symptoms and histopathological spectrum. Intracranial space occupying lesion biopsi Materials and Methods: es of 108 cases received indepartment of pathology, B.J. Medical College, Ahmedabad, during the period of March 2021 to August 2021. All specimens were preserved in 10% formalin and allowed to x for 24 hours, parafn embedded sections of 5 microns were cut. The hematoxylin and eosin stained sections of the CNS lesions were studied. One Hundred and Eight cases of Intracranial Spac Result: e Occupying lesions were studied, of which 8 (7.4%) cases were non neoplastic with 6 (75%) being cystic lesions and 2 (25%) were cerebral abscess. The neoplastic lesions comprised of 100 (92.6%) cases, which included 99 (99%) primary and 1 (1%) metastatic lesions. The most frequent type of CNS tumor was astrocytoma and oligodendroglioma (23 cases, 23%) followed by Meningioma (18 cases, 18%), pituitary adenoma (17 cases, 17%), Ependymoma(13 cases, 13 %) and metastatic tumor (1 case, 1%). The surgical pathologist plays an importa Conclusion: nt role in accurate diagnosis of various Intra [3] Cranial Space Occupying lesions which will be of immense help for patient prognosis and treatment.