Occipitomastoid Sutures Research Articles

Autonomic rehabilitation: Vagal and sympathetic impacts of modified occipitomastoid suture V-spread.

Autonomic rehabilitation using osteopathic manipulative treatment (OMT) to stimulate the vagus nerve may be a good adjunct therapy by physiatrists who treat dysautonomia. Heart rate variability (HRV) may provide quantitative evidence for the benefits of OMT on autonomic nervous system function. Elevated HRV indicates optimal health and reduced mortality risk, whereas low HRV is associated with stress, pain, and chronic disease pathology. To analyze the impact of modified occipitomastoid suture v-spread OMT technique on vagal tone by measuring HRV. Within-participant design with 5-minute HRV measurement pre- and post-OMT treatment. Clinical examination suites. Thirty healthy osteopathic medical students. A modified occipitomastoid suture v-spread treating somatic dysfunction by osteopathic physicians trained in osteopathic neuromusculoskeletal medicine. HRV variables related to vagal tone including root mean square of successive differences (RMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), high frequency (HF), Parasympathetic Nervous System Index (PNSI), and Sympathetic Nervous System Index (SNSI). Repeated measures t-test analyzed the difference in mean HRV values after OMT. There were statistically significant increases in each of the HRV measures after OMT. Participants had a mean (95% confidence interval) RMSSD of 50.5 ms (38.3-62.8) at baseline and 55.0 ms (41.2-68.7, p = .013) post-OMT. pNN50 was 24.5% (17.6-31.3, n = 30) at baseline and 28.2% (20.8-35.6, p = .003) post-OMT. HF was 1549.6 ms2 (389.8-2709.4) at baseline and 1901.8 ms2 (618.2-3185.4, p = .103) post-OMT. PNSI was -0.1 (-0.5 to 0.2) at baseline and 0.1 (-0.3 to 1.5, p < .01) post-OMT, and SNSI was 0.2 (-0.1 to 0.6) at baseline and 0.05 (-0.3 to 0.4, p < .01) post-OMT. Normalization, due to high baseline variance, results include RMSSD 1.1 ms (1.0 to 1.1, p = .012), pNN50 1.3 (1.1 to 1.4, p = .011), and HF 1.2 ms2 (1.1 to 1.4, p = .018). Modified occipitomastoid suture v-spread may provide clinical benefit through increased vagal tone and decreased sympathetic activity.

Does the distribution of Wormian bone frequencies across different world regions reflect genetic affinity between populations?

BackgroundWormian, or sutural bones, are additional, irregularly shaped bone fragments that can occur within cranial sutures. These bones may arise due to various factors, including mechanical pressure on skull bones during early ontogenetic stages, such as during artificial cranial deformations, or due to genetic and environmental influences. This study investigates the potential genetic basis of sutural bones by comparing their frequencies across diverse global regions. It analyzed 33 craniological series, encompassing 2059 crania, to assess the frequency of sutural bones in the coronal, squamous, lambdoid, and occipitomastoid sutures among skeletal populations from regions including Aboriginal Australia, Melanesia, Southeast Asia, Siberia, Europe, and Native America. Biological distances between populations were calculated using Smith’s mean measure of divergence (MMD), with results visualized through multidimensional scaling.ResultsThe analysis identified distinct clusters of Caucasian and Siberian populations. Siberian aboriginal populations are compactly grouped, consistent with mtDNA data indicating genetic roots dating back to the Neolithic inhabitants of the Lake Baikal region. Further, differentiation within these populations is linked to the founder effect and gene flow. Notably, genetically related groups like the Inuit and Chukchi of Chukotka differ from other Siberian groups. In contrast, southern Siberian populations, such as the Buryats and Mongols, are closely positioned, aligning with genetic data. The differentiation between Southeast Asian and African regions was subtler, with their clusters largely overlapping. Yet, genetic links between populations were observed in some cases. Thus, Australians, Melanesians, and Papua New Guineans were located close to each other on the multidimensional scaling map, as were two African populations.ConclusionsThe findings tentatively suggest a potential genetic component in the expression of Wormian bones, although this hypothesis requires further empirical support, particularly through genetic studies. While genetic factors may influence the expression of Wormian bones, environmental conditions and pathological processes also play significant roles. It can be suggested that Wormian bones could potentially serve as an additional tool in kinship analysis within burials; however, their utility significantly depends on the extent of their genetic influence. If future genetic studies confirm a substantial genetic component and its dominance over environmental factors, the use of these bones in anthropological and forensic analyses would receive additional validation.

Geometric growth of the normal human craniocervical junction from 0 to 18 years old.

The craniocervical junction (CCJ) forms the bridge between the skull and the spine, a highly mobile group of joints that allows the mobility of the head in every direction. The CCJ plays a major role in protecting the inferior brainstem (bulb) and spinal cord, therefore also requiring some stability. Children are subjected to multiple constitutive or acquired diseases involving the CCJ: primary bone diseases such as in FGFR-related craniosynostoses or acquired conditions such as congenital torticollis, cervical spine luxation, and neurological disorders. To design efficient treatment plans, it is crucial to understand the relationship between abnormalities of the craniofacial region and abnormalities of the CCJ. This can be approached by the study of control and abnormal growth patterns. Here we report a model of normal skull base growth by compiling a collection of geometric models in control children. Focused analyses highlighted specific developmental patterns for each CCJ bone, emphasizing rapid growth during infancy, followed by varying rates of growth and maturation during childhood and adolescence until reaching stability by 18 years of age. The focus was on the closure patterns of synchondroses and sutures in the occipital bone, revealing distinct closure trajectories for the anterior intra-occipital synchondroses and the occipitomastoid suture. The findings, although based on a limited dataset, showcased specific age-related changes in width and closure percentages, providing valuable insights into growth dynamics within the first 2 years of life. Integration analyses revealed intricate relationships between skull and neck structures, emphasizing coordinated growth at different stages. Specific bone covariation patterns, as found between the first and second cervical vertebrae (C1 and C2), indicated synchronized morphological changes. Our results provide initial data for designing inclusive CCJ geometric models to predict normal and abnormal growth dynamics.

Mastoid foramen: morphometric study in dry skulls of Colombian population

Introduction: The mastoid foramen is an anatomically inconstant opening that transmits the mastoid emissary vein. It is located either near the occipitomastoid suture or at the posterior margin of the mastoid process of the temporal bone. Knowledge of the anatomic and morphologic variations of this foramen is essential to prevent complications during surgical procedures. Objective: To describe the anatomical and morphometric characteristics of the mastoid foramen in a sample of skulls of Colombian population. Materials and methods: A cross-sectional descriptive study was carried out in 103 dry skulls (206 hemiskulls) of adults (35-55 years old) owned by the human skeletal repositories of three universities in Manizales, Colombia. The mastoid part of the temporal bone and the occipitomastoid suture were observed macroscopically to determine the prevalence and number of mastoid foramina. The morphometric characteristics of the foramina were determined using a digital caliper and each foramen was probed using 0.35mm diameter nylon. In addition, a 100mL syringe was used to filter water through the foramina in order to verify the intracranial connection of each foramen. Results: The prevalence of mastoid foramen was 94.17% (right half: 95.15%; left half: 93.20%). Moreover, 10.82%, 42.78% and 37.63% of the left and right skull halves had three, two, and one foramen, respectively. Most of the foramina (55.87%) communicated with the groove for sigmoid sinus. Conclusions: In the Colombian population, the mastoid foramen is variable in size, may be absent or have one or more foramina in each skull half, and usually communicates with the groove for sigmoid sinus, although it may communicate with other parts of the endocranium.

Short-term effects on heart rate variability of occipito-mastoid suture normalization in healthy subjects.

Occipito-mastoid structure normalization (OMSN) is an osteopathic manipulative treatment aimed at reducing tension around the jugular foramen, where cranial nerves IX, X, and XI exit the skull. The purpose of this study was to observe how heart rate variability (HRV), a marker of autonomic cardiac regulation, was modulated after an OMSN vs. a sham technique (SHAM). Pre- and post-intervention HRV was analyzed in two randomly chosen groups of 15 participants (OMSN vs. SHAM group). HRV was collected in the supine position 5 min before and 5 min after a 10-min application of either OMSN or SHAM. The time and group effect was analyzed using a two-way ANOVA. Independently from group intervention, a significant time effect induced increased HRV. No group effect differences were observed. Multiple comparisons for time and group interaction showed that the root mean square of successive differences (RMSSD), a vagally mediated HRV variable, increased to a greater extent for the OMSN group (p = 0.03) than for the SHAM group. However, both OMSN and SHAM techniques had a significant effect on HRV. Compared to a SHAM technique, OMSN had a significant effect on HRV vagally related metric RMSSD in the short term. We conclude that 10 min of OMSN may be used to induce a short-term influence on parasympathetic autonomic nervous system modulations.

Minor Suture Fusion is Associated With Chiari Malformation in Nonsyndromic Craniosynostosis.

Here, we focused on the association between minor suture fusion and Chiari malformation (CM) occurrence in nonsyndromic craniosynostosis (NSC), and evaluated how the minor suture affects the posterior cranial fossa by measuring the posterior fossa deflection angle (PFA). In this retrospective study, the clinical records of 137 patients who underwent surgery for NSC at Aichi Children's Health and Medical Center between April 2010 and May 2022 were analyzed. Clinical data from Aichi Developmental Disability Center Central Hospital was collected for 23 patients as the external validation set. Among the 137 patients, 123 were diagnosed with NSC and the remaining 14 with syndromic craniosynostosis. Of the 123 NSC patients, 23 patients presented with CM. Multivariate analysis showed that occipito-mastoid fusion was the only significant risk factor for CM ( P =0.0218). Within the NSC group, CM patients had a significantly increased PFA (6.33±8.10 deg) compared with those without CM (2.76±3.29 deg, P =0.0487). Nonsyndromic craniosynostosis patients with occipito-mastoid suture fusion had a significantly increased PFA (6.50±7.60 deg) compared with those without occipito-mastoid fusion (2.60±3.23 deg, P =0.0164). In the validation cohort, occipito-mastoid suture fusion was validated as an independent risk factor for CM in univariate analysis. Minor suture fusion may cause CM associated with NSC. Chiari malformation could develop due to an increased PFA due to minor suture fusion, which causes growth disturbance in the affected side and compensatory dilation in the contralateral side within the posterior cranial fossa.

Morphology and Morphometry of the Asterion in the South African sample within KwaZulu-Natal

IntroductionThe asterion is a meeting point formed by the union of the lambdoid, parieto-mastoid and occipito-mastoid sutures. It is the most common landmark in surgery due to its close relation to the transverse-sigmoid sinus junction. Population-specific differences were noted when determining the position of the asterion using external bony landmarks. Therefore, this study aimed to determine the anatomical position of the asterion in relation to external bony landmarks, and to determine the morphology of the asterion within the South African sample of KwaZulu-Natal. Materials and methodsThirty-six dry adult skulls were obtained from the Department of Clinical Anatomy, University of KwaZulu-Natal. The morphology of the asterion was classified according to Morales Avalos et al. (2011). While, the morphometry regarding the position of the asterion were measured in accordance with Akkaşoğlu et al. (2019) methodology. ResultsType I asterion was observed in 18 (25.0%) of the cases and Type II presented in the majority of the cases with a prevalence of 75.0%. The distances from the asterion to the respective external bony landmarks were found to have no differences with regard to laterality (p > 0.05). The South African sample of KwaZulu-Natal was found to have majority of Type II present. The measurements from the asterion to the external bony landmarks were found to be very similar to an African based population. ConclusionThis study may enhance the existing body of knowledge regarding the morphology and morphometry of the asterion, which may lead to improved outcomes when analysing radiographs and for neuro-surgery.

Posterior Fossa Horns in Hurler Syndrome: Prevalence and Regression.

Posterior fossa "horns" caused by internal hypertrophy of the occipitomastoid sutures are one of the more recently defined cranial abnormalities described in mucopolysaccharidoses, especially in Hurler Syndrome. However, details of this finding, including the development and natural history, are not well-understood. Two hundred eighty-six brain MR imaging studies of 61 patients with mucopolysaccharidosis I-Hurler syndrome treated at single institution between 1996 and 2015 were studied. Posterior fossa horn height was measured as the perpendicular distance from the tip of the horn to the expected curvature of the occipital inner table. Fifty-seven of the 61 patients (93.4%) had evidence of posterior fossa horns on at least one occasion. The initial average height of the right horn was 4.5 mm, and the left horn, 4.7 mm. Most of the posterior horns regressed before transplantation in our cohort, though the exact age was variable among the patients. Nearly all patients in our cohort had posterior fossa horns, and these horns regressed with age. The regression of the horns frequently started before transplantation. This trend has not been previously described, and it may suggest unknown effects of mucopolysaccharidosis on skull development.

Is Asterion a Reliable Surgical Landmark for the Transverse and Sigmoid Sinus Junction in Indian Skulls?

Asterion is the junction of lambdoid, parietomastoid, and occipitomastoid sutures. In traditional anatomy teaching, it is believed that asterion sits over the transverse-sigmoid sinus junction (TSSJ). It is a significant surgical landmark for the placement of a burr hole in the retrosigmoid approach. The purpose of this study was to evaluate the asterion's accuracy as a TSSJ-specific external surgical landmark in the Indian population. 16 human dried skulls were obtained from the Department of Anatomy, AIIMS, New Delhi. The point of TSSJ was taken between the two lips and just posterior to the entry of the superior petrosal sinus. Asterion internally was localized with the help of a geometrical divider. The x- horizontal/ anterior and y- vertically superior (+)/ inferior (-) distances were measured from asterion (internally) to the TSSJ by a digital vernier caliper. The mean horizontal distance (x) of the left side asterion & TSSJ was 10.3±1.0mm whereas the vertical distance (y) ranged between +2 to -4.3 mm. The mean horizontal distance (x) of the right side asterion & TSSJ was 13.5±1.4mm whereas the vertical distance (y) ranged between +3 to -4.2 mm. Asterion is not a reliable landmark for TSSJ in Indian skulls. The TSSJ with respect to asterion was found on average 10mm and 13.5mm anterior on the left and right side respectively, and mostly inferior (average 4.2mm) in 75% of the skulls. The TSSJ was closer to the asterion on the left side in comparison with the right side. However, further studies with a larger sample size will be needed to evaluate the population-specific relation of asterion with the TSSJ.

Distinctive Cranial Abnormalities in Children with Early Infancy Insulin Dependent Diabetes in Connection with Wolcott-Rallison Syndrome

Background: Abnormal craniofacial contour and deformities of the appendicular skeleton of the lower limbs can occur in connection with a long list of skeletal dysplasia. The natural history of chronic/unusual disorders can be a precise key factor towards a successful diagnostic process. Material and Methods: Three unrelated children aged 18-months, 2 and 7 year (two boys and one girl) presented with generalised skeletal mal-development compatible with multiple epiphyseal dysplasia. However, in the early months of life these children have been diagnosed with early infancy insulin dependent diabetes. Strikingly, all manifested Wormian bones over the lambdoid sutures. In addition to Progressive malalignment of the lower limbs and thoracic kyphosis associated with significant growth deficiency were the major skeletal abnormalities. Endochondral ossification was diffusely affected associated with multiple epiphyseal dysplasia and appearance of irregular and fragmented epiphyses. Results: Based on early permanent neonatal or early-infancy insulin-dependent diabetes, associated with the clinical and radiological phenotypic characterizations of multiple epiphyseal dysplasia and growth retardation as the major abnormalities in these children. Wolcott-Rallison syndrome was the highly likely diagnosis. The most interesting findings in this study; The Wormian bones, not only involved the lambdoid sutures, but also extended to involve the occipitomastoid suture. We confirmed our diagnosis via sequence analysis which revealed a homozygous nonsense gene mutation (EIF2AK3) resulting in a premature stop codon (c.2707 C&gt;T, p.R903X). Parents in two families were identified as heterozygous carriers of this mutation. Conclusion: The significance of this study is to point out the importance of analysing the skull bones in children with skeletal dysplasia. Interestingly, for the first time we detected the downward bulging of the occiput because of the abundancy of the Wormian bones (sites of maximal skull bone fragility) along the lambdoid and the occipito-mastoid sutures is by itself a highly alarming sign of progressive weakness of the weight-bearing zone (which is represented by the lambdoid and the occipitomastoid sutures). The exerting load of the cerebrum on these vulnerable and soft sutures can lead to brain swelling (a serious condition). Despite that lower limb defects in children are the most frequent deformities encountered in the departments of paediatric orthopaedics, because of the real or apparent detrimental effect that they have on gait and upright activity, and it draw immediate and alarming attention to parents. But, nevertheless, it is the responsibility of physicians to pay prompt attention for the necessity to scrutinize the skulls and the craniocervical junction in patients with long term bone disorders.

Short-term evolution of heart rate variability following occipito-mastoid suture normalization in healthy subjects

Background&#x0D; Occipito-mastoid structure normalization (OMSN) is an osteopathy manipulative treatment aiming at reducing tensions around the jugular foramen, where cranial nerves IX, X and XI come out of the skull. Tensions in this area may induce compressions of those nerves, which might imply symptoms related to those nerves dysfunctions (e.g., dysphagia, gastrointestinal issues, cardiac issues, upper body muscle pain, fatigue). Vagus nerve X is the main parasympathetic nerves of this area. Heart rate variability (HRV) is a surrogate for vagal modulation, and purpose of this study was to observe how HRV variables evolved before and after an OMSN.&#x0D; Methods&#x0D; Pre- and post- intervention HRV was analyzed in two randomly distributed groups of 15 participants. One received the OMSN and the other a SHAM technique. HRV was collected supine 5 min before and 5 min after a10-minute application of either OMSN or SHAM. HRV was analyzed on the last 4 minutes of the 5 minutes sample in time- and frequency-domain.&#x0D; Results&#x0D; HR significantly decreased in both groups (change in mean (CIM) -2.6 (4.3), and -2.3 (2.1) bpm, for NSOM and SHAM, respectively) but without difference between groups (p = 0.245). Vagally-related HRV variable root mean square of successive differences (RMSSD) increased in both groups, but in a significantly higher proportion in OMSN group (CIM 8.1 ±6.4 and 2.8 ±6.2 ms, p = 0.030 for NSOM and SHAM, respectively). No differences between groups were observed on frequency-domain analysis.&#x0D; Conclusion&#x0D; Compared to a SHAM technique, OMSN had a significant effect on HRV vagally-related metric RMSSD. This effect was measured in the very short term and thus, OMSN may be used to imply a short-term influence on parasympathetic ANS modulations. Further research are needed to investigate medium and long-term influences of this manipulation.

The morphometric analysis of mastoid foramen and mastoid emissary canal on cone-beam computed tomography (CBCT).

The purpose of this retrospective study was to assess the prevalence and morphometric features of the mastoid foramen (MF) and mastoid emissary canal (MEC) using cone-beam computed tomography (CBCT), as well as their relationship with age, sex, and side. CBCT scans of 500 patients aged 8-87years were examined retrospectively. The presence and number of MF, mean diameter of the MEC and MF, MF location, and the distance between MF and asterion were all examined. The collected data were subjected to appropriate statistical analysis. P values < 0.05 were accepted as statistically significant at a 95% confidence interval. The study included 472 patients. MF was present in 82% and absent bilaterally in 18% of the 472 patients. The prevalence of MF was 67.8% on the right side and 65.7% on the left. The mean diameter of the MF was 3.39 ± 1.48mm and the number of the MF ranged from zero to four. The mean diameter of the MEC was 2.05 ± 1.06mm and the distance between MF and asterion was 22,46 ± 5,18mm. 52.4% of the MF was observed on the occipito-mastoid suture. To prevent surgical complications, particularly those that concern the temporal and mastoid areas, radiologists should report the results of the preoperative examination of the morphometry of the MF and MEC. CBCT imaging is a reliable diagnostic method that can be used to evaluate the MEC and MF before surgical procedures.

Morphometric Study on Types of Asterion in Dry Human Skull of Nepalese Origin

Introduction: The asterion is important bony landmark of skull important for surgical approach to the posterior cranial fossa. The variation is type of asterion is due to presence or absence of lambdoidal suture, parietomastoid suture and occipitomastoid suture. Asterion is starry or triangular depression located 2.5cm behind the upper part of root of ear. Asterion is meeting point of lambdoidal suture, parietomastoid suture and occipitomastoid suture. Materials and Methods: Altogether 26 dry adult human skulls were collected from Department of Anatomy at School of Basic Sciences in Chitwan Medical College for research. Gender and ethnicity were undefined. All damaged skull and newborns are excluded. Both sides of skull were studied for location and type of asterion. The types of asterion were noted by observing the presence or absence of all three sutures. Photograph were taken and studied. Statistical analysis was done using SPSS 17. Results: Twenty-six human skulls of unknown gender were examined. Two types of asterion were observed. The type I asterion was 88.5 percent and type II asterion was 11.5 percent on both side of skull. Conclusion: we believe that there are different types of asterion present in human skull. Asterion is the important surgical landmark. Thereby, the finding may be helpful in surgical approach and intervention.

Morphometric Analysis and Variation of Pterion, Asterion and Lambda in Dry Human Skulls and Its Sexual Dimorphism

Introduction: Pterion is a H- shaped sutural junction of the frontal, parietal, squamous part of the temporal and greater wing of sphenoid bone. Asterion is a sutural junction of lambdoid, parietomastoid and occipitomastoid sutures. Lambda is the junction where lambdoid sutures and sagittal sutures meet. These sutures play an important role in infants' brain development. Flexibility of these allows the bones to overlap and hence it can pass through the brain canal easily without any damage to the brain.&#x0D; Aim: To analyse pterion asterion and lambda of dry human skulls morphologically and morphometrically and determine its sexual dimorphism.&#x0D; Materials and Methods: 40 dry human skulls were collected from the department of Anatomy of Saveetha dental college and hospitals. By excluding abnormal and damaged skulls, 20 skulls were studied. Out of 20 skulls, 11 were male skulls and 9 were female skulls. On investigation, Pterion was classified into four types: Sphenoparietal, stellate, Epipteric and Frontotemporal. Asterion was classified into types: Type-1 and Type-2 based on the presence and absence of wormian bones respectively. Lamda was classified into two types: Normal and Abnormal. Statistical analysis was done by SPSS software. Paired Sample T test was used to analyse the data.&#x0D; Results: Percentage of occurrence of different types of pterion in males and females: Sphenoparietal (59.09 % of males and 59.09 % of females), Stellate (27.7% of males and 22.2% of females), Epipteric (99% of males and 16.6% of females) and Frontotemporal (45.5% of males and 5.5% of females). Different types of Asterion: Type-1 (13.63% of males and 16.66 % of females and Type -2 (86.63% of males and 83.33% of females). Different types of Lambda: Normal (90.9% of males and 94.4% of females), Abnormal (9% of males and 5.55% of females).&#x0D; Conclusion: In the present study, there was no correlation between the male and female skulls in the presence of Pterion, Asterion and Lambda. Therefore these cannot be used as reliable parameters for determining sexual dimorphism.

Mastoid Canals and Grooves in Human Skulls: A Dry Bone Study

Background: The mastoid canals and mastoid grooves are formed within the mastoid part of temporal bones of skull, these are present on the external surface of mastoid region, anterior to the occipitomastoid suture, behind and parallel to the petrosquamous suture and anteroinferior to the asterion. The study was conducted to observe the incidence of mastoid canals and grooves in dry adult human skulls.Methods: Total of 120 dry adult human skulls consisting of 80 male &amp; 40 female were examined to determine the incidence of mastoid canals and grooves. The mastoid parts of both sides were examined for the presence of mastoid canals and grooves. Then length of mastoid canals was measured.Conclusion: Out of the total of 120 skulls, mastoid canals were observed in 8.75% of skulls. The incidence of mastoid canals was 10% in females and 8.12% in males. The incidence of mastoid grooves was 10.42% of total skulls. It was 11.88 % in male skulls and in female skulls, it was 7.55%. The knowledge of mastoid canals and grooves of the temporal bones is very useful to the neurosurgeons and ENT surgeons while doing surgery to avoid severe bleeding.

Physiologic Timeline of Cranial-Base Suture and Synchondrosis Closure.

Fusion of cranial-base sutures/synchondroses presents a clinical conundrum, given their often unclear "normal" timing of closure. This study investigates the physiologic fusion timelines of cranial-base sutures/synchondroses. Twenty-three age intervals were analyzed in subjects aged 0 to 18 years. For each age interval, 10 head computed tomographic scans of healthy subjects were assessed. Thirteen cranial-base sutures/synchondroses were evaluated for patency. Partial closure in greater than or equal to 50 percent of subjects and complete bilateral closure in less than 50 percent of subjects defined the fusion "midpoint." Factor analysis identified clusters of related fusion patterns. Two hundred thirty scans met inclusion criteria. The sutures' fusion midpoints and completion ages, respectively, were as follows: frontoethmoidal, 0 to 2 months and 4 years; frontosphenoidal, 6 to 8 months and 12 years; and sphenoparietal, 6 to 8 months and 4 years. Sphenosquamosal, sphenopetrosal, parietosquamosal, and parietomastoid sutures reached the midpoint at 6 to 8 months, 8 years, 9 to 11 months, and 12 years, respectively, but rarely completed fusion. The occipitomastoid suture partially closed in less than or equal to 30 percent of subjects. The synchondroses' fusion midpoints and completion ages, respectively, were as follows: sphenoethmoidal, 3 to 5 months and 5 years; spheno-occipital, 9 years and 17 years; anterior intraoccipital, 4 years and 10 years; and posterior intraoccipital, 18 to 23 months and 4 years. The petro-occipital synchondrosis reached the midpoint at 11 years and completely fused in less than 50 percent of subjects. Order of fusion of the sutures, but not the synchondroses, followed the anterior-to-posterior direction. Factor analysis suggested three separate fusion patterns. The fusion timelines of cranial-base sutures/synchondroses may help providers interpret computed tomographic data of patients with head-shape abnormalities. Future work should elucidate the mechanisms and sequelae of cranial-base suture fusion that deviates from normal timelines.

Protuberant Fibro-Osseous Lesion of the Temporal Bone: "Bullough Bump"-Multimodality Imaging Case Series and Literature Review.

A handful of cases of protuberant fibro-osseous lesions of the temporal bones have been described in the literature to date, with primary focus on the pathologic features. Here we review 3 cases of pathology-proved protuberant fibro-osseous lesions of the temporal bone and include a literature review with a focus on the imaging features. While rare, these lesions have near-pathognomonic imaging features defined by a location at the cortex of the outer table of the temporal bone at the occipitomastoid suture, lack of involvement of the underlying marrow, variable mineralization, and MR signal characteristics atypical of a chondroid lesion. One case in this series was FDG-avid and had occasional mitotic features, possibly reflecting an aggressive variant. Neuroradiologists should be familiar with this benign diagnosis to aid in timely identification and avoid unnecessary additional imaging.

Assessment of computed tomographic angiographysinus development combined with occipitalbone marks for the location of transverse sigmoid sinus junction

Objective: To introduce and evaluate a technique to precisely localize the transverse-sigmoid sinus junction (TSSJ) in retrosigmoid craniotomy. Methods: This was a single-center prospective randomized controlled study. Sixty-three patients, 29 male and 34 female, who would undergo retrosigmoid craniotomy admitted to Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical Universityfrom March to October 2019 were enrolled in the study and were divided into trial group and control group according to the computer-generated random numbers. Preoperative venous computed tomographic angiography (CTA) combined with 3-dimensional computed tomography computed tomography (3D CT) was randomly given to the patients(n=32). Asterion was used for identification of the TSSJ in the controls (n=31). The main outcome measures as postoperative complications and relevant intraoperative indicators were compared. Results: Incision length, craniotomy time, bone window sizein trial group were shorter or smaller than those of the controls, as(6.8±0.5) cm vs (8.0±1.5) cm, (37±8) min vs (45±15) min, (8.7±1.2) cm(2) vs (10.2±2.4) cm(2) respectively, with statistical significance (all P<0.05). No statistical significance was found in bleeding amount, incidence of sinus injury and cerebrospinal fluid leakage. While incidence of neck pain was lower in case group (15.63% vs 38.71%; P=0.04) and the remission time of incisional pain in case group was shorter [(6±1) d vs (9±2) d; P=0.01]. Conclusion: While the technique is used, the center of the keyhole should be located at transitional place of the lateral part of the occipitomastoid suture, the retromastoid ridge and the superior nuchal line. Compared with the traditional craniotomy method marked by asterion, it has great advantages in reducing incidence of postoperative complications, craniotomy time, and the remission time of incisional pain.

Immediate effects of an approach in high cervical and occipitomastoidon postural control and mobility of individuals with parkinson’s disease: case series

Introduction: Parkinson’s disease (PD) causes impairments in postural control and mobility that affect the individual’s independence. Manual therapy has been used in the treatment of these disorders and can change mobility and postural control. Objective: To assess the immediate effects of an approach in high cervical and occipitomastoid on postural control and mobility of individuals with PD. Method: Three individuals with PD, females, aged 52 to 73 years, participated in this case series. Participants were assessed immediately before and after therapeutic intervention through releases of suboccipital muscles and occipitomastoid sutures. Trunk mobility, functional mobility and postural control (center of pressure parameters - COP) were evaluated. Results: All participants demonstrated improvements in trunk mobility. Participants 1 and 2 slightly improved functional mobility. Participants 1 and 2 showed a decrease in the medial-lateral displacement of the COP. All participants showed increases in at least one direction to the limits of stability. Conclusions: The results showed that the intervention appears more effective on trunk mobility. Variables related to postural control changed with no consistent pattern. Further studies could investigate the association of other manual therapy techniques and their effects on mobility and postural control in individuals with PD.

Retrosigmoid approach assisted by high-resolution computed tomography: a cost-effective technique to identify the transverse and sigmoid sinus transition

BackgroundWhen utilizing the retrosigmoid approach (RA), accurately identifying the transverse and sigmoid sinus transition (TSST) is a key procedure for neurosurgeons, especially in developing countries restricted by the lack of expensive devices, such as the neural navigation system and the three-dimensional volumetric image-rendered system. Before operations, a computed tomography scan is a common and cost-effective method of checking patients who suffer lesions located at the cerebellopontine angle. Therefore, we present a technique using only high-resolution computed tomography to identify the transverse and sigmoid sinus transition.MethodsThis retrospective study included 35 patients who underwent retrosigmoid approach operations to resect an acoustic neurinoma with the assistance of our technique. In brief, our technique contains 4 steps: (1) All patients’ 1-mm, consecutive, high-resolution computed tomographic images that clearly displayed landmarks, such as the inion, lambdoid suture, occipitomastoid suture, and the mastoid emissary foramen, were investigated initially. (2) We selected two particular slices (A and B) among all of these high-resolution computed tomographic images in which scanning planes were parallel with the line drawn from the root of the zygoma to the inion (LZI). Slice A contained both the root of the zygoma and the inion simultaneously, and slice B displayed the mastoid emissary foramen. (3) Four points (α, β, γ, δ) were arranged on slices A and B, and point α was located at the inner surface of the skull, which represents the posterior part of the sulci of the sigmoid sinus. Point β was located at the outer surface of the skull, and the line connecting them was perpendicular to the bone. Similarly, on slice B, we labeled point γ as the point that represents the posterior part of the sulci of the sigmoid sinus at the inner surface and point δ as the point located at the outer surface of the skull, and the line connecting them was also perpendicular to the bone. The distances between point β and the lambdoid suture/occipitomastoid suture and between point δ and the mastoid emissary foramen were calculated for slices A and B, respectively. (4) During the operation, a line indicating the LZI was drawn on the bone with ink when the superficial soft tissue was pushed away, and this line would cross the lambdoid suture/occipitomastoid suture. With both the crosspoint and the distance obtained from the high-resolution CT images, we could locate point β. We also used the same method to locate point δ after revealing the mastoid emissary foramen. The line connecting point β and point δ indicated the posterior border of the sigmoid sinus, and the intersection between the line and LZI indicated the inferior knee of the transverse and sigmoid sinus transition (TSST).ResultsAll 35 patients underwent the RA craniectomies that were safely assisted by our technique, and neither the sigmoid sinus nor the transverse sinus was lacerated during the operations.ConclusionOur cost-effective technique is reliable and convenient for identifying the transverse and sigmoid sinus transition (TSST) which could be widely performed to guarantee the safety of RA craniectomy.