Area Of Skull Research Articles

The Role of Treatment-Related Parameters and Brain Morphology in the Lesion Volume of Magnetic-Resonance-Guided Focused Ultrasound Thalamotomy in Patients with Tremor-Dominant Neurological Conditions.

To determine the best predictor of lesion volume induced by magnetic resonance (MR)-guided focused ultrasound (MRgFUS) thalamotomy in patients with tremor-dominant symptoms in Parkinson's disease (PD) and essential tremor (ET) patients. Thirty-six neurological patients with medication-refractory tremor (n°19 PD; n°17 ET) were treated using a commercial MRgFUS brain system (Exablate Neuro 4000, Insightec) integrated with a 1.5 T MRI unit (Sigma HDxt; GE Medical System). Linear regression analysis was used to determine how the demographic, clinical, radiological (Fazekas scale), volumetric (total GM/WM/CSF volume, cortical thickness), and MRgFUS-related parameters [Skull Density Ratio (SDR), n° of transducer elements, n° of sonications, skull area, maximal energy delivered (watt), maximal power delivered (joule), maximal sonication time delivered, maximal mean temperature reached (T°C_max), accumulated thermal dose (ATD)] impact on ventral intermediate (VIM)-thalamotomy-related 3D volumetric lesions of necrosis and edema. The VIM thalamotomy was clinically efficacious in improving the tremor symptoms of all the patients as measured at 1 week after treatment. Multiple regression analysis revealed that T°C_max and n° of transducer elements were the best predictors of the necrosis and edema volumes. Moreover, total WM volume also predicted the size of necrosis. Our study provides new insights into the clinical MRgFUS procedures that can be used to forecast brain lesion size and improve treatment outcomes.

Co-culture bioprinting of tissue-engineered bone-periosteum biphasic complex for repairing critical-sized skull defects in rabbits.

Tissue engineering based on bioprinting technology has broad prospects in the treatment of critical-sized bone defect. Nevertheless, it is challenging to construct composite tissues or organs with structural integrity. Periosteum and stem cells are important in bone regeneration, and it has been shown that co-culture engineering system could successfully repair bone defects. Here, a strategy of co-culture bioprinting was proposed, and a tissue-engineered bone-periosteum biphasic complex was designed. Poly-L-lactic acid/hydroxyapatite (PLLA/HA) was used to construct the supporting scaffold of bone phase. Gelatin methacryl (GelMA) loaded with rabbit bone mesenchymal stem cells (BMSCs) and periosteum-derived stem cells (PDSCs) were used to simulate the extracellular matrix and cellular components of bone and periosteum, respectively, and a co-culture layer was formed between the bone and the periosteum phase. By adjusting material ratios of PLLA/HA and crosslinking time of GelMA, a complex with good mechanical strength and cell activity was constructed and then implanted into the defect area of rabbit skull. The quantitative results of imaging and histology showed that the repair effect of bone-periosteum biphasic complex group was significantly better than that of other control groups, which demonstrated that the bone-periosteum biphasic complex was advantageous to both bone repair and regeneration. In general, using the co-culture bioprinting to construct engineered tissue is a very promising strategy, which is expected to be applied in the construction of more complex tissues and solid organs for tissue repair and organ transplantation.

Neurovascular hypoxia after mild traumatic brain injury in juvenile mice correlates with heart-brain dysfunctions in adulthood.

Retrospective studies suggest that mild traumatic brain injury (mTBI) in pediatric patients may lead to an increased risk of cardiac events. However, the exact functional and temporal dynamics and the associations between heart and brain pathophysiological trajectories are not understood. A single impact to the left somatosensory cortical area of the intact skull was performed on juvenile mice (17 days postnatal). Cerebral 3D photoacoustic imaging was used to measure the oxygen saturation (sO2 ) in the impacted area 4h after mTBI followed by 2D and 4D echocardiography at days 7, 30, 90, and 190 post-impact. At 8months, we performed a dobutamine stress test to evaluate cardiac function. Lastly, behavioral analyses were conducted 1 year after initial injury. We report a rapid and transient decrease in cerebrovascular sO2 and increased hemoglobin in the impacted left brain cortex. Cardiac analyses showed long-term diastolic dysfunction and a diminished systolic strain response under stress in the mTBI group. At the molecular level, cardiac T-p38MAPK and troponin I expression was pathologic modified post-mTBI. We found linear correlations between brain sO2 measured immediately post-mTBI and long-term cardiac strain after 8months. We report that initial cerebrovascular hypoxia and chronic cardiac dysfunction correlated with long-term behavioral changes hinting at anxiety-like and memory maladaptation. Experimental juvenile mTBI induces time-dependent cardiac dysfunction that corresponds to the initial neurovascular sO2 dip and is associated with long-term behavioral modifications. These imaging biomarkers of the heart-brain axis could be applied to improve clinical pediatric mTBI management.

Zebrafish brain and skull imaging based on polarization-sensitive optical coherence tomography.

Zebrafish brain imaging is very important for the study of brain disease and regeneration. We scanned the adult zebrafish brain before and after skull removal and monitored the recovery process of a head wound by polarization-sensitive optical coherence tomography (PS-OCT) in this paper. We analyzed the structure and polarization characteristics of the brain and skull in PS-OCT images, and found their internal microstructure can be clearly identified with the polarization information. Further, we estimated the pigment distribution of the skull area and found that the density of pigment in skull is a critical factor of affecting zebrafish brain in vivo polarization imaging. Our results demonstrated that more features of brain can be displayed by introducing the polarization information, and proved high-resolution PS-OCT will play a great potential role in studying the zebrafish brain and skull.

A surgical modification in the technique of rat pinealectomy.

Several experimental intents require pineal gland removal. The main challenge of the pinealectomy surgical procedure is the hemorrhage due to the transverse sinus torn. The study aimed to modify the rat pinealectomy surgical procedure to reduce the risk of bleeding and the mortality rate. Adult male rats experienced pinealectomy surgery. A mini-drill was used to remove a small skull area in the junction of the lambda and sagittal sutures. The pineal gland was removed using a curved-head hook. Animals experienced intensive post-surgical care. Locomotion, cerebellar motor function, working memory, and anxiety were evaluated 2weeks after pinealectomy by the open field, rotarod, Y maze, and the elevated plus maze, respectively. Surgical modification reduced the bleeding risk and animal mortality rate. No significant alteration was found in locomotion and working memory. However, the pinealectomy was anxiogenic and decreased entry to the open arm. The cerebellar motor performance did not change in the rotarod test. Hematoxylin-Eosin staining of removed tissue confirmed the histology of the pineal gland. Advantages of this technique were removing a small skull area, modifying the hook insertion point to prevent damaging the brain veins, reducing the bleeding risk and the mortality rate. Surgery modification was associated with a decreased final number of animals used. Regardless of the melatonin shortage, pinealectomy affects different organs, which should be considered in the research study design.

Primary site and survival in osteosarcoma: A National Cancer Database (NCDB) analysis.

e23512 Background: Osteosarcoma (OSC) is the most common primary bone tumor and typically affects the appendicular skeleton (specifically, the long bones of the upper and lower extremities). However, this cancer can affect other regions of the body as well, such as the skull, mandible, ribs, vertebral column, and other areas involving bone and/or any articular cartilage and, to the author’s knowledge, all possible primary sites have not been investigated. The aim of this study is to see whether or not the primary site of the tumor in OSC patients may have an effect on survival outcomes. Methods: Using the NCDB, patients diagnosed with OSC between 2004-2018 were identified using ICD-O-3 histology codes 9180 through 9193. The cohort was analyzed to investigate survival outcomes in different primary sites. Univariate analysis was then performed assessing patient length of survival for each primary site subtype. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: A total of 9826 patients with known primary site that had survival data were included. The site with the best survival was the lower limb which had significantly better survival than all other primary sites. Tumors of the upper limb had highest median survival (153 months) of those with median survival reported (which was all except for lower limb). Patients with primary tumor of ribs, sternum, clavicle had a significantly better survival than both vertebral column and pelvis/sacrum/coccyx (all p < .01). Upper limb patients survived significantly longer than all groups other than the skull, face, and mandible (p < .05). The labeled primary site with the highest mean survival was the lower limb at 123.1 months and the lowest survival was the pelvis, sacrum, and coccyx, with a median survival of 54.6 months. Conclusions: This study found numerous survival differences between patients diagnosed with OSC of different primary sites. Labeled primary sites of the lower limb and upper limb were associated with best survival while the pelvis, sacrum, and coccyx were associated with worst survival. Future studies should be done to investigate variables that may impact the survival of different primary sites, including staging, treatments, time from diagnosis to treatment, socioeconomic factors, and insurance status.[Table: see text]

Numerical Study of Acoustic Holograms for Deep-Brain Targeting through the Temporal Bone Window.

Acoustic holograms can encode complex wavefronts to compensate the aberrations of a therapeutical ultrasound beam propagating through heterogeneous tissues such as the skull, and simultaneously, they can generate diffraction-limited acoustic images, that is, arbitrary shaped focal spots. In this work, we numerically study the performance of acoustic holograms focusing at the thalamic nuclei when the source is located at the temporal bone window. The temporal window is the thinnest area of the lateral skull and it is mainly hairless, so it is a desirable area through which to transmit ultrasonic waves to the deep brain. However, in targeting from this area the bilateral thalamic nuclei are not aligned with the elongated focal spots of conventional focused transducers, and in addition, skull aberrations can distort the focal spot. We found that by using patient-specific holographic lenses coupled to a single-element 650-kHz-frequency 65-mm-aperture source, the focal spot can be sharply adapted to the thalamic nuclei in a bilateral way while skull aberrations are mitigated. Furthermore, the performance of these holograms was studied under misalignment errors between the source and the skull, concluding that for misalignments up to 5°, acoustic images are correctly restored. This work paves the way to designing clinical applications of transcranial ultrasound such as blood-brain barrier opening for drug delivery or deep-brain neuromodulation using this low-cost and personalized technology, presenting desirable aspects for long-term treatments because the patient's head does not need to be shaved completely and skull heating is low.

Archaeological site Doljani – Dubine, municipality of Čapljina in Bosnia and Herzegovina. A contribution to the research of the lower course of the river Neretva

Archaeological site Doljani – Dubine, municipality of Čapljina in Bosnia and Herzegovina. A contribution to the research of the lower course of the river Neretva

Patient-specific effects on sonication heating efficiency during magnetic resonance-guided focused ultrasound thalamotomy.

During magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for refractory tremor, high temperatures must be achieved and sustained for tissue necrosis. We assessed the impact of both patient-specific as well as procedure-related factors on the efficiency of acoustic energy transfer, or heating efficiency (HE). Retrospective analysis of 92 consecutive patients (857 sonications) with essential tremor or tremor-dominant Parkinson's disease treated at a single institution. Temperature elevations at the target were measured for each sonication with MR thermometry. HE of each sonication was defined as the ratio of peak temperature elevation and the delivered energy. HE was analyzed with respect to patient skull features (area, thickness, skull density ratio [SDR]), computed from CT scans, as well as demographic and clinical variables (age, sex, diagnosis, and duration of symptoms). Across the full range of sonication energies that can be delivered with current devices (up to 36kJ), average sonication HE was diminished in patients with lower SDR. In individual subjects, there was a progressive loss in HE as sonication energy was titrated up throughout the course of treatment, with a more rapid decline in patients with higher SDR. This energy-dependent loss in HE was not related to procedural factors, namely, the number of previous sonications, or the cumulative energy deposited during previous sonications. In contrast to SDR, neither skull area nor thickness was an independent predictor of average HE or the rate of its decline with increasing energies. In 11% of patients, all of whom with SDR<0.45, sonication HE fell below the threshold to reach 54°C even with delivery of maximum energy. In contrast, temperatures 50°C could be obtained in all but one patient. SDR is predictive of sonication HE, and determines patient-specific limits on the magnitude of temperature elevation that can be achieved with current devices. These data inform strategies for predictable lesioning in MRgFUS thalamotomy.

Biodosimetry in interventional radiology: cutaneous-based immunoassay for anticipating risks of dermatitis.

Interventional radiology procedures expose individuals to ionizing radiation. However, existing dosimetry methods do not provide the dose effectively absorbed to the skin, and do not consider the patient's individual response to irradiation. To resolve this lack of dosimetry data, we developed a new external irradiation biodosimetry device, DosiKit, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. This new biological method was tested in Clermont-Ferrand University Hospital to evaluate the assay performances in the medical field and to estimate DosiKit sensitivity threshold. DosiKit was tested over 95 patients treated with neuroradiological interventions. For each intervention, lithium fluoride thermoluminescent dosimeters (TLD) were used to measure total dose received at each hair collection point (lateral and occipital skull areas), and conventional indirect dosimetry parameters were collected with a Dosimetry Archiving and Communication System (DACS). Quantitative measurement of radiation-induced H2AX protein phosphorylation was performed on 174 hair samples before and after the radiation exposure and 105 samples showed a notable induction of gammaH2AX protein after the radiological procedure. According to a statistical analysis, the threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy. With this study, we showed that DosiKit provides a useful way for mapping the actually absorbed doses, allowing to identify patients overexposed in interventional radiology procedures, and thus for anticipating risk of developing dermatitis. • DosiKit is a new external irradiation biodosimetry device, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. • DosiKit was tested over 95 patients treated with neuroradiological interventions. • The threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy and DosiKit provides a useful way for mapping the actually absorbed doses.

Custom-made Implants for Chronic In Vivo Electrophysiological Recording From Primate's Brain Based on the Reconstructed Skull Model.

In vivo neural recordings from primates require the installation of implants on the skull of the animal. Despite some improvements, current routines risk predisposition to infection and failure or impose constant discomfort by placing heaviness on the top of the head. A custom-designed imaging adapter was obtained by magnetic resonance and computerized tomography (CT) imaging of the head region. Then, based on a reconstructed skull model, the implants were designed and constructed using a computer numerical control (CNC) machine. During the surgical operation, the position of each implant was sketched on the skull, and implants were slipped onto their predicted site, following their sketched boundaries without any manual reshaping. We have performed this procedure on two monkeys. After surgery, the location of the implants has been verified by CT imaging. The recovery period was without significant complications with minimal infection. Our experiment showed that applying an image-guided design makes it possible to utilize the skull area better and gain access to brain regions. At the same time, our method reduced the possibility of gap formation between the implant and skull open skin margins. It reduces the time and cost of operation, resulting in a reduced chance of infection and failure, and provides animal-friendly operational surgery procedures. Despite some improvements, more refinements of methodology are still required. Here, we propose and report an improvement in the design and installation of low-cost biocompatible implants providing access to at least three brain regions.

The effects of oyster shell/alpha-calcium sulfate hemihydrate/platelet-rich plasma/bone mesenchymal stem cells bioengineering scaffold on rat critical-sized calvarial defects.

Engineering scaffolds combining natural biomineral and artificially synthesized material hold promising potential for bone tissue regeneration. We fabricated a bioengineering scaffold, oyster shell (OS) and alpha-calcium sulfate hemihydrate (α-CSH) as scaffold, platelet-rich plasma (PRP) as provider of growth factors and bone mesenchymal stem cells (BMSCs) as seed cells, and determined it could be applied as a new type of bone graft substitutes by rat calvarial defects repairing experiment in vitro and in vivo. SEM showed that the mean diameter of the pores was about 150 μm with a range of 50-200 μm, and scaffold's porosity was ~27.4% by Archimedes' Principle. In vitro, Scaffold + BMSCs + PRP group presented a higher ALP activity compared with other groups by ELISA (P < 0.05). But the expression of OC was not detectable on day 4 or 8. The MTT assay showed that the relative cell number of BMSCs+PRP group increased significantly (P < 0.05). In vivo, the smallest defect area of skull and highest volume of regenerated new bone were observed in Scaffold + PRP + BMSCs group by X-ray and Micro-CT analysis (P < 0.05). And the similar results also were observed in HE and Masson staining. The immunohistochemistry staining for osteogenic marker proteins ALP and OC showed that the most obvious positive staining was observed in Scaffold + PRP + BMSCs group (P < 0.05). The expression of inflammatory markers IL-6 and TNF-α was the lowest in control group (P < 0.05). In conclusion, a bioengineering scaffold based on OS, created by simply combining α-CSH and PRP and implanting with BMSCs, could be clinically useful and has marked advantages as a targeted, off-the-shelf, cell-loaded treatment option for the bone healing of critical-size calvarial defects.

МІКРОСТРУКТУРНА ХАРАКТЕРИСТИКА ПІДНИЖНЬОЩЕЛЕПНОЇ СЛИННОЇ ЗАЛОЗИ ЩУРА В НОРМІ

&#x0D; &#x0D; &#x0D; Macroanatomy, topography of the submandibular salivary glands in rats, the size and mechanisms of functioning, are determined by the characteristics of the structure of the skull and cervical area, and the horizontal position of the animal body and features of the functional purpose of the glands. Salivary glands ensure the consistency of homeostasis not only in the oral cavity, but also in the upper gastrointestinal tract, performing the primary enzymatic processing of food, helping the passage of food to the esophagus. Apparently, there are no other organs that perform as many functions (secretory, secretory, excretory, secretory) and have such a significant impact on the condition of the organism, oral cavity and digestive system as a whole.This publication demonstrates microstructures characteristics of submandibular salivary gland of rats.&#x0D; &#x0D; &#x0D;

A study of foramen magnum and its clinical relevance

Introduction: Foramen magnum is very important land mark as it is closely related with brainstem and spinal cord. Morphometric parameters of foramen magnum are required for forensic investigations & anthropological identification of unknown individual. As there is paucity of literature regarding variations in size & shape in reference to different races which prompted us for this study. Aims and Objective: The aim was to study the morphology of foramen magnum that can be applied for many invasive surgical as well as diagnostic procedures, which carried out in brain. Materials and Methods: In this cross sectional study, 50 adult human skulls were taken from the department of anatomy. Various parameters of foramen magnum like antero-posterior diameter, transverse diameter along with the measurement of area of dry human adult skull were calculated using vernier caliper to an accuracy of 0.1mm. Mean standard deviation and p value were also calculated. The distribution of shapes into oval, round, tetragonal, irregular, diamond were also assessed visually. Results: The commonest shape found was oval followed by irregular. In this study on 100 sides of 50 dry Skulls the mean Antero-posterior diameter, Transverse diameter are as 34.08 ± 2.25 mm & 28.17 ± 2.85mm. The measurement of area in foramen magnum of dry skull is 757.41±115.09 mm2. This data were then compared and analyzed with the various other studies. Conclusion: The anatomical knowledge of Foramen magnum is of great importance for Neurologist, Radiologist & Anthropologist to achieve the best exposure with appropriate surgical outcome. Keywords: Foramen magnum, Skull, Anatomical variations, Morphometric analysis.

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound Treatment at 1.5 T: A Retrospective Study on Treatment- and Patient-Related Parameters Obtained From 52 Procedures

To present a retrospective analysis of patient- and sonication-related parameters of a group of patients treated with a transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) system integrated with a 1.5-T MRI unit. The data obtained from 59 patients were retrospectively reviewed for this study. The following data were mainly collected: skull density ratio (SDR), skull area (SA), transducer elements (Tx), and estimated focal power at target (FP). For each treatment stage, we calculated the number of sonication (Sn), sonication power (Sp), measured power (Smp), sonication duration (Sd), energy (E), measured energy (Em), maximum temperature (Tmax), and MR thermometry plane orientation. Furthermore, the time delay between each sonication (St) and the total treatment time (Tt) were recorded. Fifty-two patients (40 males and 12 females; age – 64.51 ± SD 11.90; range 26–86), who underwent unilateral Vim thalamotomy (left = 50, 96.15%; right = 2, 3.85%) for medication refractory essential tremor (n=39; 78%) or Parkinson tremor (n=13; 22%) were considered. A total of 1068 (95.10%) sonication were included in our final analysis (average Sn per treatment: 20.65 ± 6.18; range 13–41). The energy released onto the planned target was found to decrease with the SDR for all temperature ranges. A positive correlation was observed between the slope of Tmax vs. Em plot and the SDR (R2=0.765; p<0.001). In addition, the Tmax was positively correlated with SDR (R2=0.398; p<0.005). On the contrary, no significant correlation was found between SDR and SA or Tx. An analysis of the MR Thermometry scanning plane indicated that, at our site, the axial and the coronal planes were mostly used. Our results confirm the factors that significantly influence the course of a tcMRgFUS procedure even when a 1.5-T MRI scanner is used for procedure guidance. The experience we gained in this study indicates that the SDR still remains one of the most significant technical parameters to be considered in a tcMRgFUS procedure. The possibility of prospectively setting the sonication energy according to the presented curves of energy delivery as a function of SDR for each treatment stage could provide a further understanding and awareness of this technology.

Forehead deformities after tissue expansion: Retrospective analysis and recommendations

Tissue expanders can lead to bone deformity as well as bone resorption. Not all changes in the cranial bone can be completely normalised after tissue expander extraction. This study aimed to investigate the potential factors for persistent forehead deformities after tissue expansion. Cases of forehead tissue expansion performed from 2011 to 2015 were retrospectively reviewed. Demographic and clinical data were collected. Two plastic surgeons (Y.Q. and C.Q.) evaluated changes in the forehead by comparing preoperative and most recent postoperative photographs. The Fisher exact, chi-square and Student t tests, and univariate and multivariate logistic regression analyses were performed in this study. Sixty-seven patients underwent forehead expanded flap reconstructions and continuous follow-ups were done in the outpatient service. The mean duration of the follow-ups after expander removal was 33.86 months. Overall, 28 (41.8%) patients had forehead changes. Age, sex, indications for tissue expansion and follow-up time were not associated with forehead changes. There were significant differences in the total injection volume and expansion period between patients with forehead changes (41.8%) and those without (58.2%). No significant negative correlation was found between the duration of pressure bandage usage post-operatively and the occurrence of forehead changes. Our recommendations for performing tissue expansion in the skull area are as follows: (1) always choose expanders with the largest base dimension; (2) perform tissue expansion as quickly as possible and (3) do not cause overexpansion. In addition, there was no proven benefit of using pressure bandages when skeletal changes occurred.

S13-07 SESSION 13: HYPERTELORISM / CRANIOFACIAL CLEFTS FLOATING FRONTAL FLAP COMBINED WITH INVERTED U-SHAPED OSTEOTOMY PROCEDURE IN ORBITAL HYPERTELORISM SECONDARY TO CRANIOSYNOSTOSES

Introduction: The clinical manifestation of orbital hypertelorism includes congenitally increased interorbital distance (the distance between bilateral lacrimale). Greg applied this term firstly in 1924. Orbital hypertelorism may be present in a variety of craniofacial deformities, such as craniofacial cleft, Apert syndrome, Crouzon syndrome and so on. However, orbital hypertelorism secondary to non-syndromic craniosynostosis is relatively rare. From 2013 to 2016, we performed modified surgery through intra-and-extra-cranial approach in three patients with congenital craniosynostosis associated with orbital hypertelorism and got satisfactory results. To report three patients who was diagnosed as orbital hypertelorism secondary to craniosynostoses treated by using inverted U-shaped osteotomy combined floating frontal flap procedure through intra-and-extra-cranial approach. Methods: Three patients diagnosed as orbital hypertelorism secondary to craniosynostosis, underwent floating frontal flap procedure combined with inverted U-shaped osteotomy by intra-and-extra-cranial approach. Inverted U-shaped orbit frame was formed and moved inward to attach the central bone bridge, with the fixation of titanium mesh and screw. Medial canthal ligament was cross fixed to contralateral orbit frame and thus the skin on inner canthus could fit bone surface tightly. With inverted U-shaped orbit frame fixed with each other, a structure of fronto-orbital bone bridge was formed. After that we made a center vertical osteotomy of the floating frontal flap and rotated both of the frontal flaps inward by 90 degrees. Appropriate shape of supraorbital area and proper volume of anterior skull were successfully achieved with the frontal flaps fixed to the fronto-orbital bone bridge. Results: These patients got satisfactory results, with the orbital distance being corrected to the normal range, meanwhile the premature fused coronary suture was released. The forehead and orbits region obtained normal appearance. Conclusion: The satisfactory result show that floating frontal flap combined with inverted U-shaped osteotomy procedure by intra-and-extra-cranial approach is one kind of safe and effective way to correct orbital hypertelorism secondary to craniosynostoses.

A potential field segmentation based method for tumor segmentation on multi-parametric MRI of glioma cancer patients

BackgroundAccurate segmentation of brain tumors is vital for the gross tumor volume (GTV) definition in radiotherapy. Functional MR images like apparent diffusion constant (ADC) and fractional anisotropy (FA) images can provide more comprehensive information for sensitive detection of the GTV. We synthesize anatomical and functional MRI for accurate and semi-automatic segmentation of GTVs and improvement of clinical efficiency.MethodsFour MR image sets including T1-weighted contrast-enhanced (T1C), T2-weighted (T2), apparent diffusion constant (ADC) and fractional anisotropy (FA) images of 5 glioma patients were acquired and registered. A new potential field segmentation (PFS) method was proposed based on the concept of potential field in physics. For T1C, T2 and ADC images, global potential field segmentation (global-PFS) was used on user defined region of interest (ROI) for rough segmentation and then morphologically processed for accurate delineation of the GTV. For FA images, white matter (WM) was removed using local potential field segmentation (local-PFS), and then tumor extent was delineated with region growing and morphological methods. The individual segmentations of multi-parametric images were ensembled into a fused segmentation, considered as final GTV. GTVs were compared with manually delineated ground truth and evaluated with segmentation quality measure (Q), Dice’s similarity coefficient (DSC) and Sensitivity and Specificity.ResultsExperimental study with the five patients’ data and new method showed that, the mean values of Q, DSC, Sensitivity and Specificity were 0.80 (±0.07), 0.88 (±0.04), 0.92 (±0.01) and 0.88 (±0.05) respectively. The global-PFS used on ROIs of T1C, T2 and ADC images can avoid interferences from skull and other non-tumor areas. Similarity to local-PFS on FA images, it can also reduce the time complexity as compared with the global-PFS on whole image sets.ConclusionsEfficient and semi-automatic segmentation of the GTV can be achieved with the new method. Combination of anatomical and functional MR images has the potential to provide new methods and ideas for target definition in radiotherapy.

Incidence, number and topography of Wormian bones in Greek adult dry skulls.

Wormian bones (WBs) are irregularly shaped bones formed from independent ossification centres found along cranial sutures and fontanelles. Their incidence varies among different populations and they constitute an anthropo- logical marker. Precise mechanism of formation is unknown and being under the control of genetic background and environmental factors. The aim of the current study is to investigate the incidence of WBs presence, number and topographical distribution according to gender and side in Greek adult dry skulls. All sutures and fontanelles of 166 Greek adult dry skulls were examined for the presence, topography and number of WBs. One hundred and nineteen intact and 47 horizontally craniotomised skulls were examined for WBs presence on either side of the cranium, both exocranially and intracranially. One hundred and twenty-four (74.7%) skulls had WBs. No difference was detected between the incidence of WBs, gender and age. Sutures and fon- tanelles located in neurocranium showed a higher incidence of WBs, contrariwise to orbital sutures that indicated a low incidence. WBs most commonly located in the lambdoid suture (44.6%), followed in order of frequency by the coronal suture (39.8%), asterion (21% on the left and 15.3% on the right side) and parie- tomastoid suture (15.1% on the left and 13.9% on the right side). Other sutures with WBs were the occipitomastoid, sagittal, squamosal, zygomaticosphenoid, metopic, frontonasal and frontozygomatic. Regarding the skull fontanelles, WBs were found at pterion, posterior and anterior fontanelles. The current study highlights a high incidence of WBs in a Greek population, indicating racial variation. The in depth knowledge of exact location, frequency and number of WBs is essential for clinicians intervening in the skull area, anthropologists and forensic surgeons investigating child abuse cases.

The Impact of the Use of Kinesio Taping Method on the Reduction of Swelling in Patients After Orthognathic Surgery: A Pilot Study.

BackgroundOrthognathic surgery (OGS) is associated with extensive surgical intervention within the soft and hard tissues of the facial region of the skull leading to inflammatory reactions. The presence of postoperative swelling indicates the accumulation of exudate or transudate; both these fluids occur in surgery. Massive swelling is a significant problem, because the tension of tissues intensifies pain sensations. The aim of the study was to evaluate the effectiveness of the kinesio taping method (KT) in patients after orthognathic surgery in the area of the facial skull in terms of eliminating postoperative swelling.Material/methodsThe study of the impact of kinesiology tape applied after orthognathic surgery to the craniofacial area on the elimination of swelling was performed in sixteen patients who suffered from this complication after bilateral sagittal split osteotomy.ResultsThe swelling was shown to be reduced after KT; within the same study the differences were statistically significant between the left and right sides and for the same side (p<0.05). The application of the lymphatic kinesio taping method led to the reduction of tension in the affected area and restoration of proper lymphatic circulation in the region covered by swelling. This allows for the improvement of the blood and lymph microcirculation and activation of self-healing processes.ConclusionsThe analysis of the impact of the practical use of the lymphatic KT on complications after orthognathic surgery revealed that it had a beneficial effect on the reduction of swelling. The use of the KT method seems promising because it is simple to carry out, not traumatic, economical and rarely causes undesirable allergies.