Sphenoidal Research Articles

Clinical and imaging features of 112 patients with irregular and flat bone osteosarcoma

This study evaluated the clinical characteristics and imaging findings of 112 patients with irregular and flat bone osteosarcoma (IFBO). The age, gender, location, tumor size, density and signal intensity, osteoid matrix, periosteal reaction, and histological subtypes were analyzed for 112 patients with IFBO. A total of 112 patients with IFBO, including 64 males and 48 females, with a mean age of 34.8 years were enrolled in this study. Over half of the tumors (54.5%) were detected in the craniofacial region and the skull (24 in the maxilla bone, 17 in the mandible bone, 11 in the sphenoid bone, 7 in the temporal bone, 1 in the frontal bone, and 1 in the occipital bone). Other tumor locations included the pelvic region (20.5%; 20 in the ilium and 3 in the pubis), the chest (18.8%; 11 in the scapula, 7 in the ribs, and 3 in the clavicle), and the vertebrae (6.3%; 3 in the thoracic spine, 2 in the lumbar spine, 1 in the sacrum, and 1 in the cervical spine). Transarticular extension occurred in 11 of the 23 pelvic cases (47.8%), primarily involving the sacroiliac joint (90.9%; 10 of 11). Six cases (6/7; 85.7%) of vertebral osteosarcoma arose from the transverse process and the pedicle, and 1 (1/7; 14.3%) arose from the sacral tuberosity and the ala, with partial vertebral body involvement. Additionally, 27 patients (24.1%) presented with secondary osteosarcoma related to prior radiotherapy, and 2 (1.8%) were associated with osteoblastoma and fibrous dysplasia. Histological examination revealed high-grade tumors in 88 (78.6%) cases. The tumors presented as soft-tissue masses with a diameter of 7.5±3.2 cm. A total of 91 patients underwent X-ray examination and/or computed tomography (CT) examinations. The osteoid matrix was detected in 84 patients (84/91;92.3%). A periosteal reaction was detected in 56 cases (56/91; 61.5%), including a lamellar periosteal reaction in 10 patients (11.0%) and a spiculated periosteal reaction in 46 cases (50.5%). All 74 cases who underwent magnetic resonance imaging (MRI) examinations presented with heterogeneous masses in the surrounding soft tissue. Enhancement was homogenous in 12 cases (18.5%) and heterogeneous in 53 cases (81.5%). Peripheral rim enhancement was observed in 10 cases (13.5%). IFBO should be considered when diagnosing patients over 30 years of age who exhibit osteoid matrix in bone lesions. Maxillofacial osteosarcoma is commonly associated with a history of radiation exposure. Pelvic osteosarcoma is more likely to invade the sacroiliac joint. Vertebral osteosarcoma frequently arises in the transverse process and pedicle, with partial body involvement.

Estimation of gender and age through the angulation formed by the pterygoid processes of the sphenoid bone

To obtain angular measurements formed from the junction of the bilateral pterygoid processes of the sphenoid bone through computed tomography scans of the conical beam of the sphenoid bone, in order to correlate them with the estimation of gender and age in a human identification process. 602 computed tomography (CBCT) scans were selected – 301 males and 301 females. The tomographic images were analyzed, in low light conditions, independently the using of the free access software Radiant DICOM Viewer and, within the program, an angle calculation tool was applied on top of the axial cut in the union of the pterygoid processes medial and lateral bilaterally. The collected data were quantified in tables according to their age and gender, in addition to being statistically analyzed. There was no correlation between increasing age and the angles formed by bilateral pterygoid processes. But there is a statistically significant difference between the values of the angles between males and females on the left and right sides, t(600) = 2,6186 (p-value = 0,0091) and t(600) = 3.3593 (p- value = 0,0008), respectively. Based on our results, there are statistically significant differences between genders in relation to the angles formed by the pterygoid processes of the sphenoid bone, with higher descriptive values in men with older ages.

Case Report: Chemotherapy and Radiotherapy Combined With DC-CIK for Pulmonary and Mediastinal Metastases From Nasopharyngeal Carcinoma

IntroductionThe optimal treatment for pulmonary and mediastinal metastasis of nasopharyngeal carcinoma (NPC) is still controversial, and the therapeutic effect is poor recently. In one case, we demonstrated a long-term survival after postoperative chemoradiotherapy combined with dendritic cell and cytokine-induced killer (DC-CIK) immunotherapy for pulmonary and mediastinal metastases from NPC.Baseline CharacteristicsA 53-year-old woman was admitted to our hospital in June 2008. Pathological biopsy revealed a poorly differentiated squamous cell carcinoma located in the nasopharynx with the invasion of internal pterygoid muscles, the sphenoid bone, and unilateral neck lymph node metastasis. No distant metastases were observed. The stage of NPC was T3N1M0 III (AJCC8). The patient received concurrent chemoradiotherapy for primary lesion and neck lymph nodes and achieved complete remission (CR) of the disease after 3 months. Follow-up at 3-month intervals was carried out. Pulmonary and mediastinal lymph node metastases were found in July 2009. The patient then underwent right upper lobectomy and mediastinal lymph node dissection and five cycles of gemcitabine and cisplatin (GP) regimen chemotherapy, following radiotherapy and DC-CIK immunotherapy.ResultsAfter a follow-up time of 13 years, no tumor recurrence or metastasis and severe adverse reactions were found.ConclusionPostoperative chemotherapy and radiotherapy in combination with DC-CIK immunotherapy may produce a synergistic therapeutic effect on patients with mediastinal lymph node metastasis from NPC.

Orbital and Periorbital Dysmorphology in Untreated Pfeiffer Syndrome.

Visual impairment secondary to orbital and periorbital dysmorphology is frequent in Pfeiffer syndrome patients. The etiopathogenesis of this aberrancy, however, remains unclear. Untreated Pfeiffer syndrome patients (n = 31) and normal control subjects (n = 43) were compared. Craniometric and volumetric analyses related to the orbital and periorbital anatomy were performed using Materialise (Leuven, Belgium) software. Overall, orbital cavity volume of Pfeiffer patients is reduced by 28 percent (p < 0.001), compared to normal, starting before 3 months of age (p = 0.004). Globe volume was diminished by 10 percent (p = 0.041) before 3 months of age, yet tended to catch up thereafter. However, the retrobulbar soft-tissue volume remained smaller beyond 1 year of age (17 percent, p = 0.003). Globe volume projection beyond the bony orbit increased in all observed ages (82 percent, p < 0.001). The volumes of sphenoid bone, maxilla, and mandible proportionately were restricted by 24 to 25 percent (p = 0.003 to 0.035) before 3 months of age. The volume of maxilla and mandible gradually approximate normal; however, the sphenoid bone volume in Pfeiffer patients remains less than normal (p = 0.002) into childhood. The anteroposterior length of both the zygoma and the maxilla was reduced by 14 percent (p < 0.001). Anterior positioning of the zygoma is less by 23 percent (p < 0.001) in Pfeiffer patients overall, with anterior positioning of maxilla reduced similarly by 23 percent (p < 0.001). Pfeiffer syndrome patients develop decreased retrobulbar soft-tissue and globe volume, along with a restricted orbital cavity volume in infancy. Significant hypoplasia of the sphenoid bone is associated with more severe central facial (maxilla) retrusion, compared to lateral facial structures (zygoma). Risk, II.

How I do it: decompressive hemicraniectomy supplemented with resection of the temporal pole and tentoriotomy for malignant ischemic infarction in the territory supplied by the middle cerebral artery

Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death.MethodThe surgical technique of performance of decompressive hemicraniectomy involves removal of an extensive bone flap in the fronto-temporo-parieto-occipital zone with resection of the temporal squama and of the greater wing of the sphenoid bone to visualize the level of entrance of the middle meningeal artery to the cranial cavity, which, in its turn, allows resection of the upright margin of the middle cranial fossa. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy.ConclusionPerformance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period.

Proptosis secondary to a solitary plasmacytoma of the sphenoid bone: a case report on a rare skull base tumour

BackgroundPlasmacytomas of the skull base are not commonly encountered in clinical practice, with few reported cases in the literature. They form part of the spectrum of plasma cell neoplasms and are classified as a solitary bone plasmacytoma if arising from the sphenoid bone. Its radiographic appearance can lead to misdiagnosis as one of the tumours that are more frequently seen in the skull base, especially meningiomas. Due to the risk of evolution into multiple myeloma, accurate diagnosis is essential.Case presentationA 56-year-old male presented to the emergency department with rapid proptosis and worsening vision in his right eye for one week’s duration. Imaging studies revealed an extra-axial right sphenoid bone tumour with invasion into the temporalis muscle and orbit, leading to significant proptosis. Tumour debulking was done, but there was no improvement in vision postoperatively. Final histology was consistent with a plasmacytoma. The patient was referred to the oncologist for radiation therapy, but subsequently developed further lesions consistent with multiple myeloma.ConclusionsPlasmacytomas need to be considered in the differential diagnosis of skull base tumours. Due to their excellent response to radiation, these patients should have early oncology intervention to prevent irreversible neurological deficits.

Changes in the Sphenoid Bone Encountered During the Endoscopic Endonasal Transsphenoidal Approach.

We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA). During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre- and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three-dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross-Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino-Nasal Outcome Test-20 (SNOT-20), and visual analog scale (VAS) evaluation. The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P=.046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT-20, and VAS scores) (all P > .05). Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re-operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA. 4 Laryngoscope, 132:965-972, 2022.

Sphenoid bone metastasis in lung cancer: An unusual finding

1. Turner RC, Lucke-Wold BP, Hwang R, Underwood BD. Lung cancer metastasis presenting as a solitary skull mass. J Surg Case Rep. 2016;2016(6):rjw116. doi:10.1093/jscr/rjw116 CrossRef Google Scholar

Hypoplasia of medial pterygoid process in sphenoid bone relates to decreased mesenchymal cell proliferation in the Runx2-haploinsufficient cleidocranial dysplasia mouse model

ObjectiveHypoplasia of the medial pterygoid process of the sphenoid bone is a distinct skeletal phenotype in runt-related transcription factor 2 (Runx2) heterozygous mice and patients with cleidocranial dysplasia. The aim of this study was to investigate the involvement of Runx2 in hypoplasia by regulating cell proliferation in the mesenchymal cell condensation region. DesignA total of thirty mouse embryos were used. The medial pterygoid process region in the Runx2+/+, Runx2+/-, and Runx2-/- mouse embryos were histologically investigated. Immunohistochemistry for Runx2 and proliferating cell nuclear antigen (PCNA) was carried out. ResultsIn embryonic day 14.5, mesenchymal cell condensation appeared at the future medial pterygoid process in Runx2+/+ mice, but was obscure in Runx2+/- mice. In these areas, cells showed a dual expression of Runx2 and PCNA in both Runx2+/+ and Runx2+/- mice. However, the number of Runx2- and PCNA-positive cells was decreased in Runx2+/- mice. In Runx2-/- mice, mesenchymal cell condensation appeared on embryonic day 18.5 at the medial pterygoid process region, associated with a few PCNA-positive cells. Moreover, the PCNA-positive cell rate in the medial pterygoid process was significantly lower in Runx2-/- mice than in Runx2+/+ and Runx2+/- mice. On embryonic day 18.5, Runx2+/- and Runx2-/- mice showed significantly shorter axial length of medial pterygoid process compared to that in Runx2+/+ mice. ConclusionsThe present study demonstrates that Runx2 is involved in cell proliferation in the mesenchymal cell condensation region of the medial pterygoid process during mouse embryonic development.

Multiple pterygoid approach: A novel technique with single-piece implants.

The intended target site to engage a fixture distal into the tuberosity is the pterygoid apophysis that comprises the maxillary tuberosity, pyramidal process of the palatine bone, and the pterygoid process of the sphenoid bone. Pterygoid implants are incorrectly labeled in literature owing to the fact that they are actually root form conventional implants and should hence be termed as 'tubero-pterygoid implant'. An implant engaging the pterygoid apophysis/pillar taking distal maxillary support and avoiding successfully the cantilever situation is called a pterygoid implant. It essentially does not acquire primary with support of distal maxilla initially from the tuberosity. Instead, it makes its way into the apophysis and sometimes via a transsinus approach. A tubero-pterygoid implant, because of the root form screw shape fixture that is wide at the crestal aspect and converging toward the apex, takes the primary support from the tuberosity and engages the pterygoid pillar apically, thus allowing more bone to implant contact but has its limitation in deficient/atrophied tuberosity.

SPHENOID BONE DYSPLASIA-A CASE OF UNRESOLVED HEADACHE IN PRIMARY CARE

Headache is a very common presenting symptom in patients seeking treatment in primary care. Although most of it is primary headache, physicians may easily miss the diagnosis of secondary headache. Therefore, we need to equip ourselves with adequate knowledge together with a good and thorough physical examination to avoid missing a diagnosis of secondary headache. In addition to that, for a patient presenting with chronic headache, it is very important for us to always review our diagnosis and our management. We reported a case of sphenoid bone fibrous dysplasia who presented with severe recurrent headache despite being given treatment, analgesics and even propranolol for migraine. Fibrous dysplasia accounts for approximately 5 to 7 percent of benign bone tumours. He presented to the primary care clinic multiple times before the imaging was ordered. Subsequent MRI showed fibrous dysplasia of the right lesser wing of the sphenoid bone. After the surgery, the headache improved as well as his quality of life.

Optic chiasmatic potential by endoscopically implanted skull base microinvasive biosensor: a brain-machine interface approach for anterior visual pathway assessment.

Background: Visually evoked potential (VEP) is widely used to detect optic neuropathy in basic research and clinical practice. Traditionally, VEP is recorded non-invasively from the surface of the skull over the visual cortex. However, its trace amplitude is highly variable, largely due to intracranial modulation and artifacts. Therefore, a safe test with a strong and stable signal is highly desirable to assess optic nerve function, particularly in neurosurgical settings and animal experiments.Methods: Minimally invasive trans-sphenoidal endoscopic recording of optic chiasmatic potential (OCP) was carried out with a titanium screw implanted onto the sphenoid bone beneath the optic chiasm in the goat, whose sphenoidal anatomy is more human-like than non-human primates.Results: The implantation procedure was swift (within 30 min) and did not cause any detectable abnormality in fetching/moving behaviors, skull CT scans and ophthalmic tests after surgery. Compared with traditional VEP, the amplitude of OCP was 5-10 times stronger, more sensitive to weak light stimulus and its subtle changes, and was more repeatable, even under extremely low general anesthesia. Moreover, the OCP signal relied on ipsilateral light stimulation, and was abolished immediately after complete optic nerve (ON) transection. Through proof-of-concept experiments, we demonstrated several potential applications of the OCP device: (1) real-time detector of ON function, (2) detector of region-biased retinal sensitivity, and (3) therapeutic electrical stimulator for the optic nerve with low and thus safe excitation threshold.Conclusions: OCP developed in this study will be valuable for both vision research and clinical practice. This study also provides a safe endoscopic approach to implant skull base brain-machine interface, and a feasible in vivo testbed (goat) for evaluating safety and efficacy of skull base brain-machine interface.

Morphometric Analysis of Anterior Clinoid Process and Optic Strut: A Cadaveric Study

Introduction: Anterior Clinoid Process (ACP) is a bony projection on the posterior border of lesser wing of sphenoid. It is related to optic nerve, internal carotid and ophthalmic arteries. Optic strut (OS) is a bony formation located between upper side of body and lesser wing of sphenoid bone. Aim: To observe the variations in length, width of ACP and location of optic strut on right and left side in dry skulls among South Indian population. Materials and Methods: An observational study was done in the Department of Anatomy, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India, from August 2021 to December 2021. Total 37 dry skulls were collected from department and also from bone sets from first year MBBS (Bachelor of Medicine and Bachelor of Surgery) students. Various parameters (length, width of ACP, distance from tip of ACP and OS, distance between tips of ACP) were measured on both sides using digital vernier callipers. Independent t-test was applied to compare the means of different groups. Results: Mean width of ACP was 14.86±4.47 mm on right side and 12.71±3.13 mm on left side (p-value 0.019). Mean length was 12.45±2.85 mm on right side and 12.05±3.11 mm on left side (p&gt;0.05). Mean distance from tip of ACP to optic strut was 9.48±2.86 mm on right side and 9.31±3.03 mm on left side (p&gt;0.05).Distance between the tips of ACP ranged from 27.09±28.89 mm and mean was 26.29±3.77 mm. Optic strut was located at anterior two-fifth of ACP on right side in 17 (45.95%) and on left side in 14 (37.83%) of skulls. Conclusion: There was variation in mean width of ACP on right and left side. The knowledge will help in preoperative planning and preventing unnecessary injury to neurovascular structures present in vicinity of anterior clinoid process and optic strut.

Morphometry of Sella Turcica, Anterior Clinoid Process and Carotico-clinoid Foramen among North Indian Population: A Cross-sectional Study

Introduction: Sella Turcica (ST), a complex bony landmark located on the body of sphenoid bone. Its lateral bony wall mainly consists of anterior and posterior clinoid processes and optic strut which bear a strong relationship with pituitary fossa. Aim: To estimate various morphometric parameters of ST, Anterior Clinoid Process (ACP) with its anatomical variations, Optic Strut (OS) and Carotico-clinoid Foramen (CCF) among North Indian population group. Materials and Methods: The present cross-sectional anatomical study was conducted on 30 adult dry fully ossified skull and 10 formalin fixed adult cadaveric cranial base present in the Department of Anatomy, SGT University Gurugram, Haryana, India, over a period of one year from January 2021 to December 2021 to evaluate various morphometric parameters such as anteroposterior, transverse diameter and depth of sellar region including ACPs with various bony distances. The range, mean and standard deviation of each parameters were measured by using Statistical Package for the Social Sciences (SPSS) latest version (version 21.0) and Student’s t-test was applied for bilateral comparison. Frequency of morphological variability of CCF was calculated in percentages. Results: Among the 40 samples (both dry skull base and cadaveric skulls) the average dimensions of ST were 10.03±2.40 mm, 13.65±2.09 mm and 5.74±1.92 mm as anteroposterior, transverse and depth, respectively. The length, width and thickness of ACP were 11.22±1.74 mm, 8.04±1.73 mm and 2.27±0.70 mm, respectively. Also the length and width of OS were 3.61±0.78 mm and 3.72±0.47 mm, respectively. Significant difference was observed for distance of ACP to OS. The frequency of CCF was 10 (25%) among the total samples both bilateral and unilateral; out of which 8 (80%) of the samples presented with incomplete foramen, 1 (10%) presented contact type of CCF, and 1 (10%) of the samples exhibited a complete variety of CCF. Conclusion: Bilateral significant difference was observed for the transverse diameter. The mean value for length of ACP was found significant. Detailed morphometry and morphological variations of structures present in sellar region is mandatory for the clinicians specially neurosurgeons and radiologist for the diagnosis and to decide the modality of treatment.

Histological examination of cranial synchondroses as functionally significant elements in the cranial osteopathic concept

Introduction. In recent decades, medical science has accumulated convincing evidence of the fact that the normal activity of a human brain depends on the functional integration of its vascular system, a circulation system of cerebrospinal fluid and biomechanical features of a skull, forming a single structural and functional system.The aim of the study is to research the histological structure of functionally significant cranial synchondroses in the middle and elderly age group, to find possible points of osteopathic influence application in their structure. Materials and methods. The study was performed on cadaver material of 27 persons (7 men — 26 %, 20 women — 74 %) who died at the age from 49 to 66 years (57,5±5,3 years) from various somatic pathologies, but had no history of craniocerebral injuries with fractures of osseous structures. Small bone fragments with sutures of interest/synchondroses (spheno-occipital synchondrosis, petro-jugular synchondrosis, sphenopetrosal synchondrosis) were subjected to standard histological processing followed by microscopy.Results. Evaluating histological specimens of spheno-occipital synchondrosis, we observed the similar pattern: highly mineralized tissues at the edges of the bodies of the sphenoid and occipital bones were connected without elements of cartilagi-nous or connective tissue. In all cases, no fibrous or nerve tissue elements were found during the in situ immunohistochemical reactions. Reactions with the CD34 antibody mark multiple vessels of the Volkmann's or Haversian canals. Evaluating histological specimens of petro-jugular and sphenopetrosal synchondroses, we found the presence of cartilage tissue in the suture in the form of small islands of various sizes (from 20 to 120 microns) with signs of degeneration and a small number of remained chondrocytes. When evaluating specimens with immunohistochemical reactions with antibodies against the S100 protein, no elements of the nervous tissue were detected.Conclusion. Spheno-occipital synchondrosis has a temporary nature. With age, its cartilaginous tissue is replaced by osseous one. According to the histological structure, sphenobasilar synchondrosis demonstrates the complete absence of a cartilaginous component in the middle and elderly age groups. Petro-jugular and sphenopetrosal synchondroses retain the cartilaginous component in their suture throughout lifetime. During histological examination of the petro-jugular and sphenopetrosal synchondroses, the cartilaginous component is represented by variety of small islands. In all synchondroses, there is an absence of vascular and nervous components. At the same time, we revealed the presence of a prominent vascular bed in the bone tissue. The fact requires emphasizing the importance of liquid potency and elastic component in cartilaginous and osseous tissues as an application point for osteopathic techniques.

The Posterior Part Influences the Anterior Part of the Mouse Cranial Base Development.

ABSTRACTThe cranial base is a critical structure in the head, which is composed of endoskeletal and dermal skeletal. The braincase floor, part of the cranial base, is a midline structure of the head. Because it is a midline structure connecting the posterior skull with the facial region, braincase floor is critical for the orientation of the facial structure. Shortened braincase floor leads to mid‐facial hypoplasia and malocclusions. During embryonic development, elongation of the braincase floor occurs through endochondral ossification in the parachordal cartilage, hypophyseal cartilage, and trabecular cartilage, which leads to formation of basioccipital (BO), basisphenoid (BS), and presphenoid (PS) bones, respectively. Currently, little is known about whether maturation of parachordal cartilage, hypophyseal cartilage, and trabecular cartilage occurs in a simultaneous or sequential manner and if the formation of one impacts the others. Our previous studies demonstrated that loss of function of ciliary protein Evc2 leads to premature fusion in the intersphenoid synchondrosis (ISS). In this study, we take advantage of Evc2 mutant mice to delineate the mechanism governing synchondrosis formation. Our analysis supports a cascade mechanism on the spatiotemporal regulation of the braincase floor development that the hypertrophy of parachordal cartilage (posterior side) impacts the hypertrophy of hypophyseal cartilage (middle) and trabecular cartilage (anterior side) in a sequential manner. The cascade mechanism well explains the premature fusion of the ISS in Evc2 mutant mice and is instructive to understand the specifically shortened anterior end of the braincase floor in various types of genetic syndromes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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.

Frequency of Pituitary Adenoma among the Patients with Chronic Headache

Background: Antero-superior, Pituitary Gland lies in vicinity of optic chiasm and antero-inferiorly, it is related with posterior wall of sphenoid bone. Pituitary Gland is consisting of three lobes: Anterior, intermediate and posterior and their secretion are regulated by hypothalamus.&#x0D; Aims and Objectives: To identify pituitary adenoma in the patients coming with complain of chronic headache.&#x0D; Materials and Methods: Seven hundred sixty-four patients were included in our study. All the patients with chronic headache with/without decreased vision and visual field defects were included our study. Those patients already diagnosed with any other cause of headache such as uncontrolled blood pressure, tumor or diagnosed case of pituitary adenoma and patient with glaucoma were excluded. Detailed history was taken and ocular examination was done. MRI orbit and brain with contrast was done in all patients.&#x0D; Results: Out of 764 patients, 32 patients were diagnosed as having pituitary adenoma. Macro-adenoma was present in 30 patients and micro-adenoma in 2 patients. On MRI majority of patients had optic chiasm compression with bi-temporal hemianopia.&#x0D; Conclusion: All the patients with chronic headache with/without visual disturbances and visual field defect must be properly examined and investigated as that will help other researchers to diagnose the Pituitary Adenomas.

A Study of the Morphological Variation in the Shape and Size of Sella Turcica in the Population of Benghazi

Sella Turcica is a saddle-shaped depression, located in the middle cranial fossa on the upper surface of the sphenoid bone. The morphology of Sella Turcica is significant for evaluating treatment outcomes and late developmental changes and especially in assessing the cranial morphology. This study aims to estimate the normal variation in the shape and measurement of Sella Turcica (length, depth, antero-posterior diameter) as well as the differences between genders and age groups. This research is a descriptive cross-sectional study and included adult patients (N=100) in Al-Howary Radiology Centre, Benghazi in the period between the 1st of April 2018 and the 31st of March 2019. Participants in the sample were purposively selected. Data was then collected and transferred to SPSS Software Version 23 and the analysis was completed. An independent sample t-test was used to examine the differences between two independent groups and the relationships between two independent categorical variables was examined through chi-square analysis. ANOVA was used to compare more than two means. The morphology of the Sella Turcica appeared to be normal in shape in 36.3% of males and 31.3% of females. The oblique anterior wall was noted in 36.3% of males and 15% of females, the Sella Turcica bridge was recorded in 6.1% of males and 12% of females, the notching posterior wall of Sella was present in 1.2% of males and 31.3% of females and the pyramidal shape of dorsum Sella was recorded in 6.1% in males and 10.4% of females. There was no difference in the linear dimensions of Sella Turcica when the various age groups were compared, however, there was a difference in depth between age groups which was statistically significant (P= 0.001). The anatomy of the Sella Turcica and its surroundings is significant for neurologists and neurosurgeons with regard to their clinical assessments. The Sella shapes and dimensions reported in the current study can be used as reference standards for further investigations involving the Sella Turcica in Libyan subjects.

Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach.

Introduction Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.