Frontal Calvarium Research Articles

34. Osteoradionecrosis of frontal calvarium presenting as non-healing lesions of the fronto-temporal region

34. Osteoradionecrosis of frontal calvarium presenting as non-healing lesions of the fronto-temporal region

Applications of supraorbital keyhole craniotomy in pediatric cranial trauma: illustrative series of two cases and systematic literature review.

Minimally invasive (MIS) approaches to neurosurgical diseases continue to increase in popularity due to their association with decreased infection risk, shorter recovery time, and improved cosmesis. Cosmesis and lower morbidity are especially important for pediatric patients. The supraorbital keyhole craniotomy (SOKC) is one MIS approach shown to be effective for both neoplastic and vascular pathologies in pediatric patients. However, it is limited data on its use in pediatric trauma patients. Two cases employing SOKC in pediatric trauma patients are presented here along with a systematic review of the literature. We queried PubMed, Scopus, and Web of Science databases from inception to August 2022 using the Boolean search term: (supraorbital OR eyebrow OR transeyebrow OR suprabrow OR superciliary OR supraciliary) AND (craniotomy OR approach OR keyhole OR procedure) AND (pediatric OR children OR child OR young) AND "trauma". Studies that discussed the use of an SOKC in a pediatric patient having sustained trauma to the frontal calvarium and/or anterior fossa/sellar region of the skull base were included. Details were extracted on patient demographics, trauma etiology, endoscope use, and surgical and cosmetic outcomes. We identified 89 unique studies, of which four met inclusion criteria. Thirteen total cases were represented. Age and sex were reported for 12 patients, 25% of whom were male; the mean age was 7.5years (range: 3-16). Pathologies included acute epidural hematoma (9), orbital roof fracture with dural tear (1), blowout fracture of the medial wall of the frontal sinus with supraorbital rim fracture (1), and compound skull fracture (1). Twelve patients were treated with a conventional operating microscope, while one underwent endoscope-assisted surgery. Only one significant complication (recurrent epidural hematoma) was reported. There were no reported cosmetic complications. The MIS SOKC approach is a reasonable option for select anterior skull base trauma in the pediatric population. This approach has been used previously for successful frontal epidural hematoma evacuation, which is often treated by a large craniotomy. Further study is merited.

Statistical shape analyses of trigonocephaly patients

Surgery is the first treatment option for patients with metopic craniosynostosis. Fronto-orbital advancement is the preferred method for correction of isolated trigonocephaly, but it is hard to understand whether surgery has been successful mainly in an early period. We aim to investigate the shape differences in the head shapes of trigonocephaly patients compared between preoperative and postoperative term. Cranial shape data were collected from the two-dimensional digital images. The Generalized Procrustes analysis was used to obtain mean shapes of the preoperative and postoperative term. The shape deformation of the frontal calvarium from preoperative to the postoperative term was evaluated using the thin-plate spline (TPS) method. There was significant cranial shape difference between preoperative and postoperative term. The high-level deformations for preoperative to postoperative term determined seen in TPS graphic. Highest deformation was observed at the bifrontal dimension especially at nasion and posterior edge of the forehead. In this study, we showed that the shape difference and structural deformation of the calvarium were correlated with the metopic craniosynostosis. The present study also shows that preoperative and postoperative head shapes of patients with trigonocephaly can be compared using the landmark-based geometrical morphometric method by taking into consideration the topographic distribution.

BRAIN TUMOR: AN INCIDENTAL FINDING ON A ROUTINE ORTHODONTIC RADIOGRAPHIC EVALUATION

Background Plain radiographs allow for easy examination of lesions in the oral and maxillofacial region and occasionally reveal some incidental findings. There are sporadic case reports of such incidental lesions.1 Primary brain tumors are a group of various diseases that represent the most common solid tumors of childhood.2 The Central Brain Tumor Registry of the United States estimates around 4300 newly diagnosed cases among U.S. children per year.3 Brain tumors are categorized on the basis of histology; however, tumor location and extent of spread are also essential factors that influence treatment plan and prognosis. Immunohistochemical, cytogenetic, and molecular genetic analyses and proliferative activity measurements are often applied in tumor diagnosis and classification.2 Tumors are usually classified as infratentorial, supratentorial, parasellar, or spinal. Neurologic symptoms, such as seizures, personality changes, headache, nausea, and lethargy, can indicate the location and size of the tumor.4 Brain tumors frequently arise in the posterior fossa after the first year of life.5 Clinical and Radiologic Findings In this case report, we describe the case of a 13-year-old female referred to the Oral and Maxillofacial Radiology Department for evaluation of an incidental calcified frontal lobe lesion. The patient was seeking treatment in the Department of Orthodontics for crossbite. Posteroanterior cephalometric radiography revealed a 5 × 6 cm, relatively well-defined, mixed-density, lobulated, calcified mass located in the left frontal lobe. Interpretation On magnetic resonance imaging (MRI), the lesion was seen as expansile, partially cystic, and having small internal enhancing components and low signal areas both on T1-weighted and T2-weighted sequences, compatible with calcifications. There as extensive cortical involvement of the left frontal lobe, with extension to the left lateral ventricle and thinning and remodeling of the overlying left frontal calvarium. Discussion/Conclusions Differential diagnosis included oligodendroglioma, ganglioglioma, and hemangioma. The patient was referred to a neurosurgeon for further management.

Malignant primary intraosseous meningioma in a pediatric patient: A case report and review

Abstract Introduction This is the first case of a malignant, pediatric PIOM reported in the United States. Primary extradural meningiomas (PEM) arise in locations other than dura, outside the intracranial compartment. Primary Intraosseous Meningiomas (PIOMs) are a rare subset of PEM that arise in bone. Case report A 16 year old female, neurologically intact, mildly tender swelling over her right forehead that increased in size, accompanied by headaches and dizziness. Imaging demonstrated a lesion infiltrating the frontal calvarium and the adjacent intracranial and extracranial soft tissues. Surgical resection was performed. Pathology supported the diagnosis of anaplastic meningioma (WHO grade III). Discussion PIOMs are a rare subset arising in bone. In an extensive review, less than 150 cases of PIOMs were found. It likely originates from entrapment of arachnoid cap cells, congenitally or after development. Treatment is similar to intradural meningiomas, namely a potentially curative resection. Resection and cranioplasty should be performed simultaneously. Adjuvant radiation, chemotherapy and bisphosphonates are recommended.

Single-Step Primary Reconstruction After Complex Fronto-Orbital Brown Tumor Resection Using Computed-Designed Peek Implant

The authors describe a patient with secondary hyperparathyroidism (HPT) who had develop- ment of a brown tumors (BTs) of the superior orbit and frontal calvarium with subsequent visual impairment. One-step surgery involving wide en-bloc resection of the entire tumor and immediate fronto-orbital reconstruction with a custom-made polyetheretherketone (PEEK) im- plant was planned. Using a PEEK implant a one-step reconstruction of the fronto-orbital region was achieved obtaining symmetry and good functional results, reducing operative time and avoiding donor site morbidity.

RARE-05BIFRONTAL OSTEOMA IN CONJUNCTION WITH CALVARIUM HEMANGIOMA: FIRST REPORTED CASE

INTRODUCTION: Osteomas are benign osteogenic neoplasms of cancellous bone that typically occur in the head and neck as a single lesion. They may be central, peripheral or extra-skeletal and typically involve the frontal sinus. Hemangiomas are exceedingly rare benign tumors that arise from intra-skeletal vasculature. They are typically located in the vertebral body with calvarium involvement occurring less commonly. To our knowledge, no prior cases have been reported in the literature of bifrontal bone osteoma that co-occurs with frontal bone hemangioma. CASE: A 65-year-old female presented with a 4-month history of a painless mass developing over her right eyebrow. On physical exam patient had a nonpainful immobile growth. Magnetic Resonance Imaging (MRI) revealed a peripheral enhancing mass of the right frontal calvarium without breach apparent to the inner or outer table or sinus involvement. Computed Topographic (CT) imaging showed a mixed density, expansile lesion consistent with a hemangioma inside the right frontal calvarium. The patient underwent a bifrontal craniectomy where the hemangioma was resected in conjunction with the second bony lesion. Pathology results confirmed a frontal osteoma in conjunction with a hemangioma of the calvarium. The patient underwent an uncomplicated clinical course with no adjuvant therapy. The patient is presently 4 months post-operation with no evidence of recurrence. CONCLUSION: Osteomas rarely occur as multiple lesions, especially in the absence of sinus involvement. In similar tone, hemangiomas themselves are rare lesions, with calvarium origin reported as a less common location. Both osteoma and hemangioma are benign lesions and treatment for each alone is surgical excision without the need of adjuvant therapies. As such, this coincidence of lesions is unprecedented, making it difficult to determine the clinical or prognostic significance of this patient's presentation and treatment outcomes.

Focal Cranial Hyperostosis From Meningioma

Nearly 75% of childhood cancer survivors will experience an adverse late effect from previous therapy. In patients previously treated with cranial irradiation, the late effect can manifest as secondary central nervous system tumors. Presented is a case of a 20 year man with a history of T-cell lymphoblastic leukemia diagnosed at age 22 months, treated with chemotherapy and cranial irradiation. He had developed increasing prominence of the top of his head over several months. Plain radiograph showed frontal calvarium thickening with focal "hair-on-end" periosteal reaction. Magnetic resonance imaging revealed an enhancing dural-based mass with transcalvarial extension, confirmed after resection to be meningioma (World Health Organization Grade I). This case illustrates an atypical presentation of a late effect of childhood cancer treatment and highlights the need to be informed about prior treatments received and potential attendant complications.

The “Power” Brow Lift: Efficient Correction of the Paralyzed Brow

Purpose. To describe a novel approach to brow ptosis correction and evaluate its long-term efficacy in patients with facial-paralysis-associated brow ptosis.Methods. Twenty-two patients aged from 50 to 90 years underwent “power” brow lifting, involving 3 intrabrow stab incisions and suture suspension of the brow to the frontal calvarium via titanium miniplate. Long-term results of the operation were assessed retrospectively. Pre- and postoperative photographs were measured with FACE-gram software to evaluate efficacy of the procedure.Results. Seventeen patients who underwent “power” brow lift were available for postoperative evaluation. Among them, follow-up length ranged from 12 to 448 days. The average post-operative change in brow height was 5.7 mm, which was statistically significant (). There were no complications.Conclusions. The “power” brow procedure can help to restore upper facial symmetry and visual fields and improve periocular hygiene. The operation is easily performed in an office setting, under local anesthesia, and appears to provide reliable long-term results. The time required to perform the procedure is far less than that required for a standard direct brow lift; there is no risk of postoperative forehead hypesthesia, and there is no superciliary scar.

Alveolar soft part sarcoma of the frontal calvarium and adjacent frontal lobe

Alveolar soft part sarcoma is a rare tumor affecting mainly adolescent and young children. It presents as a slowly growing tumor and is usually overlooked due to lack of symptoms. Early metastasis is a characteristic feature of this tumor and, in a good number of cases, metastasis to the lung or brain is the first manifestation of the disease. In this report, we present a case of alveolar soft part sarcoma predominantly located in the right frontal bone with dural breach and contiguous right frontal lobe involvement in a 17-year-old girl without any evident primary or other secondaries. A brief review of literature is also presented.

Plasmacytoma of the Skull

A 42-year-old woman presented with a painless, nickel-sized lump on her scalp that was first noticed by her hairdresser 4 months earlier. Physical examination revealed a firm, nontender, subcutaneous nodule, 6 cm in diameter, and no neurologic deficits. A complete blood count, complete metabolic profile, and urinalysis showed no abnormalities. A computed tomographic scan showed a destructive, well-demarcated, soft-tissue mass, with peripheral bony fragments, emerging from the right frontal calvarium. The mass measured 5 cm by 4 cm and was compressing part of the brain. There was no evidence of a midline shift. The mass was excised, and cranial mesh . . .

Brown Tumor of Secondary Hyperparathyroidism Involving the Superior Orbit and Frontal Calvarium

A 29-year-old white man with chronic renal failure on hemodialysis presented with a subacute onset of painful proptosis, inferior displacement and limited upgaze of his right globe, and a tender, palpable fronto-temporal mass beneath the right scalp. A cranio-orbitotomy was performed to completely excise a large, necrotic, multilocular, cystic, heterogeneous mass. Histopathologic examination with light microscopy demonstrated the characteristic findings of a giant cell tumor. Based on the patient's history of renal failure and laboratory evidence of hyperparathyroidism, a diagnosis of brown tumor was determined.

Management of complications of frontal sinus and frontal bone fractures

Complications related to untreated and treated fractures of the frontal calvarium, frontal sinus, and anterior skull base are, fortunately, uncommon. However, when they do occur, disturbing alterations in appearance and life-threatening infections may result, alone or in combination. Extensive reconstructive procedures may be required to restore defects that affect the contour of the forehead or position of the globe. These procedures should not be undertaken until all infection in the frontal and ethmoid sinuses and the frontal bone have been controlled and the chance of recurrent infection in the sinus reduced to a minimum. A rational approach to the management of the injured frontal sinus, based on an understanding of the pathophysiology of drainage system dysfunction, is mandatory for these goals to be achieved. Patients must be made aware that have a life-long risk of additional problems, even with appropriate managment of their initial complications.

Scintigraphic Cerebral Spinal Fluid Leak Study in a Child With Recurrent Meningitis After Resection of a Frontal Meningocele

An In-111 DTPA cerebrospinal fluid (CSF) leak study was performed on a 3-year-old boy admitted with recurrent meningitis. He was born with a congenital encephalocele that was surgically resected at 7 days-of-age. A residual skull floor defect with a recurrent tumor of the nasal radix was clinically suspected. Computed tomography and MRI scans could not confirm or rule out the presence of a CSF leak. The scintigraphic study clearly demonstrated a leak into the left naris. A large leptomeningeal cyst extending down into the left nares was resected and a defect in the left frontal calvarium, identified as the source of the CSF leak, was repaired at surgery.