Vault Sutures Research Articles

Anatomical Variations in the Pseudosylvian Fissure Morphology of Brachy-, Dolicho-, and Mesaticephalic Dogs.

The purpose of the study is the following: (1) to anatomically characterize the right and the left pseudosylvian fissure (Psf) morphology; (2) to determine Psf variations between both hemispheres and between the three considered groups; and (3) to understand how these variations may influence brain surgery for dogs. Also we sought to determine whether there are any potential differences between brachy- (B), dolicho- (D), and mesaticephalic (M) dogs. The present study considered 138 brain hemispheres (N = 138) from 69 adult dog cadavers and used bregma craniometric point (b- the junction of coronal and sagittal cranial vault sutures) to characterize the Psf location on the superolateral brain surface. For statistical analysis, P values <0.05 were considered significant. The Psf was easily identified in all specimens at both hemispheres. Statistically significant differences for Psf width were registered between the groups, presenting M as the narrowest Psf regions. Fissure body length can be sorted in ascending order as D < M < B in both hemispheres, with the left Psf bigger than the right for all considered skulls. The greatest difference was registered in the B group with the left Psf 25.0% bigger than the right. Bregma has proved to be useful to appoint Psf location as more superior or inferior in the encephalic lateral surface, exhibiting in all groups the left Psf a superior position. For the groups the most inferior location was registered in M and the most superior in D. Understanding the Psf morphology and anatomical variations may provide important information to ensure safer intracranial procedures.

Fronto-orbital advancement: Revisited

Introduction: Craniosynostosis is a pathologic condition resulting from the premature fusion of cranial vault sutures, resulting in craniofacial deformities. Anterior craniosynostosis can involve a combination of metopic/unicoronal or bicoronal sutures. Aims and Objectives: Fronto-orbital advancement (FOA) is the standard surgical treatment. This article attempts to highlight the importance of modifying the osteotomies and reshaping of the cranial vault based on individual requirements to achieve the best possible result. Method and Results: Three consecutive cases of anterior craniosynostosis (metopic with unicoronal, unicoronal with sphenoethmoidal, bicoronal) with individual modifications of the technique used in each case are presented. Conclusion : FOA has to be tailored for each variant of anterior craniosynostosis and its requirements. The Technical variations can be applied to any combination of anterior craniosynostosis.

Testing the applicability of six macroscopic skeletal aging techniques on a modern Southeast Asian sample

Most macroscopic skeletal aging techniques used by forensic anthropologists have been developed and tested only on reference material from western populations. This study examined the performance of six aging techniques on a known age sample of 88 Southeast Asian individuals. Methods examined included the Suchey-Brooks method of aging the symphyseal face of the os pubis (Brooks and Suchey, Hum. Evol. 5 (1990) 227), Buckberry and Chamberlain's (Am. J. Phys. Anthropol. 119 (2002) 231), and Osborne et al.'s (J. Forensic Sci. 49 (2004) 1) revisions of the Lovejoy et al. (Am. J. Phys. Anthropol. 68 (1985) 15) method of aging the auricular surface of the ilium, Iscan et al.'s (J. Forensic Sci. 29 (1984) 1094, J. Forensic Sci. 30 (1985) 853) method of aging the sternal end of the fourth rib, and Meindl and Lovejoy's (Am. J. Phys Anthropol. 68 (1985) 57) methods for aging both lateral-anterior and vault sutures on the cranium. The results of this study indicate that application of aging techniques commonly used in forensic anthropology to individuals identified as Asian, and more specifically Southeast Asian, should not be undertaken injudiciously. Of the six individual methods tested here, the Suchey–Brooks pubic symphysis aging method performs best, though average age estimates were still off by nearly 10 years or greater. Methods for aging the auricular surface perform next best, though the Osborne et al. method works better for individuals below 50 years and the Buckberry and Chamberlain method works better for those above 50 years. Methods for age estimation from the sternal ends of the fourth rib and vault and lateral-anterior cranial sutures perform poorly and are not recommended for use on remains of Southeast Asian ancestry. Combining age estimates from multiple indicators, specifically the pubic symphysis and one auricular surface method, was superior to individual methods. Data and a worked example are provided for calculating the conditional probability that an individual belongs to a particular age decade, though overall age estimates may still be broad.

A MULTISCALE COMPUTATIONAL MODEL FOR THE GROWTH OF THE CRANIAL VAULT IN CRANIOSYNOSTOSIS.

Craniosynostosis is a condition defined by premature closure of cranial vault sutures, which is associated with abnormalities of the brain and skull. Many causal relationships between discovered mutations and premature suture closure have been proposed but an understanding of the precise mechanisms remains elusive. This article describes a computational framework of biological processes underlying cranial growth that will enable a hypothesis driven investigation of craniosynostosis phenotypes using reaction-diffusion-advection methods and the finite element method. Primary centers of ossification in cranial vault are found using activator-substrate model that represents the behavior of key molecules for bone formation. Biomechanical effects due to the interaction between growing bone and soft tissue is investigated to elucidate the mechanism of growth of cranial vault.

Identification of skull base sutures and craniofacial anomalies in children with craniosynostosis: utility of multidetector CT

Craniosynostosis is a condition characterised by the premature fusion of one or more of the cranial sutures. The aim of the study was to identify, by multidetector computed tomography (CT), the involvement of vault sutures as well as of the skull base sutures (named "minor" sutures). The latter ones are involved in development of craniofacial and skull base deformities. We retrospectively reviewed 27 children with complex synostosis (n=21) and anterior synostotic plagiocephaly (n=6). High-resolution CT images with bone definition algorithm and tridimensional volume rendering reconstructions were assessed. In 27 children we found different sutures involved in the synostotic process, including both major and minor skull suture synostosis, and synostosis of synchondroses. Superior orbital rim deformity, nasal root deviation, anterior endocranial axis deviation (ethmoidal axis) are found in children with coronal arch synostosis, while reduced size of the posterior fossa and Chiari 1 malformation are noted in children with lambdoid arch synostosis. High-resolution CT allows an accurate identification of both "major" and "minor" skull base suture synostosis and it represents the gold standard for the diagnosis of craniostenosis and for planning the proper surgical approach.

Molecular Analysis of Twist1 and FGF Receptors in a Rabbit Model of Craniosynostosis: Likely Exclusion as the Loci of Origin

Craniosynostosis is the premature fusion of the cranial vault sutures. We have previously described a colony of rabbits with a heritable pattern of nonsyndromic, coronal suture synostosis; however, the underlying genetic defect remains unknown. We now report a molecular analysis to determine if four genes implicated in human craniosynostosis, TWIST1 and fibroblast growth factor receptors 1–3 (FGFR1–3), could be the loci of the causative mutation in this unique rabbit model. Single nucleotide polymorphisms (SNPs) were identified within the Twist1, FGFR1, and FGFR2 genes, and the allelic patterns of these silent mutations were examined in 22 craniosynostotic rabbits. SNP analysis of the Twist1, FGFR1, and FGFR2 genes indicated that none were the locus of origin of the craniosynostotic phenotype. In addition, no structural mutations were identified by direct sequence analysis of Twist1 and FGFR3 cDNAs. These data indicate that the causative locus for heritable craniosynostosis in this rabbit model is not within the Twist1, FGFR1, and FGFR2 genes. Although a locus in intronic or flanking sequences of FGFR3 remains possible, no direct structural mutation was identified for FGFR3.

Craniosynostosis

Craniosynostosis is a premature pathologic fusion of one or more cranial vault sutures that leads to abnormal shape of the skull. The fused sutures lead to restricted growth in some areas and compensatory bossing in other areas. The head may assume different shapes depending upon the site and timing of the abnormally fused suture. The exact cause of this suture pathology is still unknown, but the local dura, cranial base and the fibroblast growth factors seem to influence this. The diagnosis rests on clinical examination and confirmation is generally on the computed tomography scan. The need for surgery is both for cosmetic and functional reasons. Many cases may be associated with raised intracranial pressure with its attendant deleterious effects on vision and brain. The aim of treatment is to increase the cranial volume and reshape the skull. The surgery can be safely undertaken around 9-12 months in most of the cases. The conventional management is through an open surgical approach; although, some centres have claimed impressive results with limited endoscopic techniques in selected cases. The review article deals with the aetiopathogenesis, clinical presentations and management of the common varieties of craniosynostoses seen in the Indian scenario.

High-resolution imaging of craniofacial sutures: new tools for understanding the origins of craniosynostoses

The developmental genetics and the biomechanics of sutures are well-studied topics, while their microanatomy is still imperfectly known. Here, we aim to investigate the structure of skull vault sutures using a high-resolution imaging device. We used synchrotron X-ray microtomography in order to obtain high-resolution images of skull vault sutures from an extant mammal (the mouse Mus musculus) and from an extinct fish (the placoderm Compagopiscis croucheri). We used segmentation and 3D reconstruction softwares in order to reveal the microanatomy of sutures in these species. The high-resolution images allowed us to study the distribution of osteocytes, the organisation of vascular canals, the shapes of the suture borders, the insertion of Sharpey's fibres, the bone growth lines and the structure of the soft tissues surrounding the sutures. Synchrotron imaging provides new perspectives for the study of the normal microanatomy of sutures. The submicronic resolution of the synchrotron scans gives access to the 3D organisation of structures that were previously only known in 2D, even in normal sutures. The description of anatomical entities such as vascular canals and Sharpey's fibres in abnormally fused sutures would be of interest in the understanding of craniosynostoses.

V241 RECTUS SHEATH COLPOSUSPENSION WITH POLYPROPYLENE MESH FOR VAGINAL VAULT PROLAPSE REPAIR

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V241 RECTUS SHEATH COLPOSUSPENSION WITH POLYPROPYLENE MESH FOR VAGINAL VAULT PROLAPSE REPAIR Marthinus L.S. De Kock, J. Wilna Steenkamp, Kenneth Du Toit, and Chris F. Heyns Marthinus L.S. De KockMarthinus L.S. De Kock Cape Town, South Africa More articles by this author , J. Wilna SteenkampJ. Wilna Steenkamp Cape Town, South Africa More articles by this author , Kenneth Du ToitKenneth Du Toit Cape Town, South Africa More articles by this author , and Chris F. HeynsChris F. Heyns Cape Town, South Africa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vaginal vault prolapse after previous hysterectomy is a challenging form of pelvic organ prolapse since 75% of affected women have a concomitant cysto-, recto- and/or enterocele. This video demonstrates transabdominal vaginal vault prolapse repair with rectus sheath colposuspension using polypropylene mesh. METHODS Vaginal examination and cystoscopy are performed to evaluate the extent of cysto-, recto- and enterocele. Three tissue clamps are applied to the vaginal vault. Through a transverse suprapubic incision the plane between the detrusor and the peritoneum is opened. The tissue clamps in the vagina are pushed upwards, identifying the vaginal vault for dissection. Three sutures of polypropylene zero are placed through the vaginal vault. Cystoscopy is performed to assess the extent of elevation. A sheet of polypropylene mesh 10 x 15 cm is folded double and tied to the three vaginal vault sutures. The free end of the mesh is split in two, each half is pulled through an incision in the rectus sheath on either side, folded down and sutured to itself, and the sheath is closed with polypropylene zero. RESULTS We present the results at a minimum of 4 years followup in 40 women with vaginal vault prolapse after previous hysterectomy (mean patient age 60, range 42-82 years). Previous bladder suspension had been performed in 50% of the patients. Pre-operative symptoms included urinary incontinence in 55%, recurrent urinary tract infection in 38% and incomplete bladder emptying in 30%. Concomitant rectocele repair was performed in 30%, a midurethral sling was placed in 20% and Burch colpopexy was performed in 5%. The most common complication was occurrence of a secondary rectocele in 17.5% requiring subsequent posterior repair. Vaginal vault prolapse recurred in 5% and secondary stress incontinence occurred in 2.5% of cases. CONCLUSIONS Rectus sheath colposuspension with polypropylene mesh using an open extraperitoneal approach is a simple and cost-effective surgical technique for the treatment of severe vaginal vault prolapse. The main advantage, compared to transperitoneal open or laparoscopic sacrocolposuspension, is that it is an extraperitoneal procedure, with consequently lower morbidity. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e99 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marthinus L.S. De Kock Cape Town, South Africa More articles by this author J. Wilna Steenkamp Cape Town, South Africa More articles by this author Kenneth Du Toit Cape Town, South Africa More articles by this author Chris F. Heyns Cape Town, South Africa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Authors’ response

We appreciated the interesting comments of Uccella et al. about our paper [ [1] Ceccaroni M. Berretta R. Malzoni M. et al. Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study. Eur J Obstet Gynecol Reprod Biol. 2011; 158: 308-313 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar ]. As previously stated, different aspects can play a role in the genesis of vaginal cuff dehiscence, such as vault infections, wound hematoma, resumption of sexual activity before complete healing, advanced age, previous radiation therapy, chronic steroid administration and trauma [ [2] Iaco P.D. Ceccaroni M. Alboni C. et al. Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?. Eur J Obstet Gynecol Reprod Biol. 2006; 125: 134-138 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar ]. Uccella et al. underlined that the route by which colporrhaphy is performed represents an important factor influencing the risk of dehiscence. In a retrospective review, the authors reported that laparoscopic and robotic vault sutures showed a higher risk of dehiscence when compared with the trans-vaginal approach [ [3] Uccella S. Ghezzi F. Mariani A. et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. 2011; (March) [Epub ahead of print] Google Scholar ]. Moreover, in this series, the vaginal route not only seemed to allow better results but also was shown to be an easier procedure compared with laparoscopic colporrhaphy. Deep rectal and parametrial infiltrating endometriosis with monolateral pudendal nerve involvement: case report and laparoscopic nerve-sparing approachEuropean Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 153Issue 2PreviewWe report a case of a 32-year-old woman, referred to our unit for pelvic pain syndrome with severe constipation, dyschezia, dysmenorrhea and ano-genital pain refractory to hormonal and opioid therapy. The patient reported catamenial irradiation of pelvic pain to the right ano-genital region and to her right leg, with impaired motility and sensitivity during pain peaks. Pain was evaluated using a visual analogue scale (VAS) [1], which showed unbearable dyschezia (VAS score = 10), severe dysmenorrhea (VAS score = 8) and right pudendal neuralgia (VAS score = 9). Full-Text PDF Vaginal cuff dehiscence after laparoscopic hysterectomyEuropean Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 161Issue 1PreviewWe read with much attention the very interesting paper by Ceccaroni et al. entitled “Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study” [1]. The article evaluates different important features of vaginal evisceration after hysterectomy (i.e. time of onset, trigger event, presenting symptoms). Among the other strengths, the article has the merit to present data from a large population (more than 8000 patients), and to stress the difference between the various approaches to hysterectomy, in terms of risk of vaginal cuff dehiscence. Full-Text PDF

Fusion of Skull Vault Sutures in Relation to Age-A Cross Sectional Postmortem Study Done in 3rd, 4th &amp; 5th Decades of Life

Introduction: Cranial suture closure is one trait that has been used since the 16th century for age estimation after 2nd decade of life. There exists considerable debate about its applicability and reliability in age estimation. Objective: To find out the pattern of cranial vault suture closure in relation to age in 3rd to 5th decades of life; to detect bilateral and bisexual variations in cranial suture closure; and to specify any relationship between progression of union of cranial suture and age. Materials and method: Study design: Cross-sectional observational study. Study period: November 2008 to October 2009. Sample size: 70. All the autopsy cases, between 21 to 50 years of age were studied for relation between age and cranial suture closure. Ectocranial and endocranial closure pattern were studied for sagittal coronal and lambdoid sutures. Results: Endocranial fusion of cranial suture was more regular than ectocranial fusion, and was observed as early as 21-30 years. Coronal suture was the first to fuse. Closure was found earlier in females compared to males. No definite correlation was found to exist between age and suture closures. Conclusion: With this study, we couldn’t find any possibility for suture closure to contribute substantially as one to the factors for age estimation.

Brief communication: Ectocranial suture closure in Pongo: Pattern and phylogeny

Ectocranial suture fusion patterns have been shown to contain biological and phylogenetic information. Previously the patterns of Homo, Pan, and Gorilla have been described. These data reflect the phylogenetic relationships among these species. In this study, we applied similar methodology to Pongo to determine the suture synostosis progression of this genus, and to allow comparison to previously reported data on other large-bodied hominoids. We hypothesized these data would strengthen the argument that suture synostosis patterns reflect the phylogeny of primate taxa. Results indicate that the synostosis of vault sutures in Pongo is similar to that reported for Gorilla (excluding Pan and Homo). However, the lateral-anterior pattern of fusion, in which there is a strong superior to inferior pattern, for Pongo is unique among these species, reflecting its phylogenetic distinctness among great ape taxa.

Palatine Sutures as Age Indicator: A Controlled Study in the Elderly

Vault sutures have proven their low reliability for estimating age at death in individual forensic science cases. We broke down the palatine sutures of 134 skulls (with known sex and age at time of death) into 15 subparts and 5 stages of fusion to obtain a mean coefficient of obliteration (Cp) which was then linked to five age classes. We completed this study with multiple regression equations of total palatine suture scores. We compared our results with those obtained using the Mann method on the one hand and classically segmented and scored ectocranial suture age determination methods on the other. Palatine sutures generally do not estimate age at death any better than cranial vault sutures. Despite the partly subjective aspect of suture study, palatine suture observation contributes additional information to age-range estimation, especially in old and very old subjects where other methods lose their effectiveness.

Pediatric craniofacial surgery for craniosynostosis: Our experience and current concepts: Part -1

Craniostenosis is a disease characterized by untimely fusion of cranial sutures resulting in a variety of craniofacial deformities and neurological sequelae due to alteration in cranial volume and restriction of brain growth. This involves vault sutures predominantly, but cranial base is not immune. Association with a variety of syndromes makes the management decision complex. These children need careful evaluation by multiple specialists to have strategic treatment options. Parental counseling is an important and integral part of the treatment. Recent advancements in the surgical techniques and concept of team approach have significantly enhanced the safety and outcome of these children. We had an opportunity of treating 57 children with craniostenosis in the last 15 years at our craniofacial service. Out of them, 40 were nonsyndromic and 17 were syndromic variety. We describe our successful results along with individualized operative technical modifications adopted based on the current understanding of the disease.

MOC-PS(SM) CME Article: Management Considerations in the Treatment of Craniosynostosis

After studying this article, the participant should be able to: 1. Recognize the anatomical characteristics of the individual forms of craniosynostosis. 2. Differentiate deformational plagiocephaly from craniosynostosis. 3. Identify the pros and cons of individual types of craniosynostosis operations (i.e., endoscopic craniectomy and open cranioplasty procedures). 4. Understand risks of operative procedure versus the natural history of untreated craniosynostosis. The term "craniosynostosis" refers to the premature fusion of one or more cranial vault sutures and its associated skull deformities. The pattern of skull deformities for each of the sutures (metopic, coronal, sagittal, and lambdoid) is characteristic from patient to patient, although variable in the degree of severity. The skull pattern is predictable in that restriction of growth occurs in a plane perpendicular to the plane of the fused vault suture, and compensatory changes occur frequently, parallel to it. When skull deformities are recognized with midfacial and extremity deformities, often the craniosynostosis is referred to as syndromic, implying a genetic basis for the skeletal maldevelopment. Indications for surgery relate to benefits in changing the shape of the skull toward normal and potentially avoiding brain maldevelopment. Brain injury is presumed to be related to local or regional increases in intracranial pressure. A broad range of surgical options to treat craniosynostosis exist, from strip craniectomy to comprehensive, or whole vault, cranioplasty. The optimal surgical timing for these approaches must balance both the desire for early intervention to reduce the effects of bone restriction on brain growth and the ability of a child to withstand the rigors of surgery. Complications of surgery include blood loss, bone defects, and scalp scarring. The most common, significant, postoperative complication, however, is incomplete correction of the skull deformity. Infection in nonsyndromic synostosis surgery is rare. Team management and longitudinal follow-through will aid in determining efficacy and safety of the available surgical approaches.

The influence of artificial cranial vault deformation on the expression of cranial nonmetric traits: Its importance in the study of evolutionary relationships

Nonmetric cranial traits have been commonly used in evolutionary relationship studies. They develop during the growth and development of an individual, and for this reason its expression presents different sources of genetic and nongenetic variation. However, the use of these features in evolutionary relationship studies carries the implicit assumption that much of the nonmetric trait variation is essentially genetic. Among the nonheritable factors, cranial vault deformation has been the most studied in human populations. Because of the widespread distribution and elevated rate of artificial cranial vault deformation found in America, and the importance of nonmetric traits in evolutionary relationship studies in this area, the objectives of this paper are as follows: (a) to study the influence of artificial cranial vault deformation on the presence of nonmetric traits within samples of human craniofacial remains; and (b) to establish artificial cranial vault deformation influence on evolutionary relationships between local populations on a regional scale. Our results indicate that artificial cranial vault deformations alter the variation and covariation of metric and nonmetric traits in some samples. Wormian bones, placed in cranial vault sutures, are the most influenced by this factor. However, our results suggest that when all nonmetric traits were used the artificial cranial vault deformation did not influence the basic pattern of variation among samples. The exclusion or inclusion of wormians bones in evolutionary relationships analysis did not modify the results, but using only wormians bones lead to inconsistent results indicating that these traits have little value on these kind of studies.

Modeling of Scaphocephaly Using Superelastic Titanium-Nickel Rings: A Preliminary Report

As long as resection of sagittal suture eliminates craniostenosis it leads to desired cranium broadening and shortening solely in the case of children under six months of age. In the majority of cases, especially in older children, boat-shaped cranium remains rather unchanged and its effective modeling requires extensive dissection and osteotomy of the whole cranium vault (e.g., frontal, occipital and parietal bones). Lauritzen's method is an alternative solution. It consists of distraction of cranium vault bones with the aid of steel springs. In order to simplify and improve the efficacy of treatment since 2002, the authors originated the application of titanium-nickel rings to model the cranium. After the sparing excision of cranium vault sutures in the shape of letter "H" the compressed ring is given in the sagittal axis oval shape and in this form it is fixed to osseous margins. The ring's expansion at the same time broadens and shortens the cranium vault. Material was analyzed from 7 children (range, 9 months to 4 years of age), who were treated in the years 2002-2006 because of sagittal craniostenosis. Observations made so far and good treatment results indicate purposefulness of discussed treatment continuation.

Craniosacral Therapy: The Effects of Cranial Manipulation on Intracranial Pressure and Cranial Bone Movement

Quasi-experimental design. To determine if physical manipulation of the cranial vault sutures will result in changes of the intracranial pressure (ICP) along with movement at the coronal suture. Craniosacral therapy is used to treat conditions ranging from headache pain to developmental disabilities. However, the biological premise for this technique has been theorized but not substantiated in the literature. Thirteen adult New Zealand white rabbits (oryctolagus cuniculus) were anesthetized and microplates were attached on either side of the coronal suture. Epidural ICP measurements were made using a NeuroMonitor transducer. Distractive loads of 5, 10, 15, and 20 g (simulating a craniosacral frontal lift technique) were applied sequentially across the coronal suture. Baseline and distraction radiographs and ICP were obtained. One animal underwent additional distractive loads between 100 and 10,000 g. Plate separation was measured using a digital caliper from the radiographs. Two-way analysis of variance was used to assess significant differences in ICP and suture movement. No significant differences were noted between baseline and distraction suture separation (F = 0.045; P>.05) and between baseline and distraction ICP (F = 0.279; P>.05) at any load. In the single animal that underwent additional distractive forces, movement across the coronal suture was not seen until the 500-g force, which produced 0.30 mm of separation but no corresponding ICP changes. Low loads of force, similar to those used clinically when performing a craniosacral frontal lift technique, resulted in no significant changes in coronal suture movement or ICP in rabbits. These results suggest that a different biological basis for craniosacral therapy should be explored.

A new technique for dissecting the bladder laparoscopically

To evaluate a new technique designed to facilitate bladder dissection during laparoscopic-assisted vaginal hysterectomy (LAVH). Minimal access surgery unit, James Cook University Hospital. A retrospective review of 130 LAVHs in which the bladder was dissected laparoscopically. A metal catheter was used to facilitate identification of the bladder edge, and a sponge forceps was inserted vaginally to mark the site for anterior colpotomy. Then monopolar scissors were used to open the vagina. The hysterectomy was then completed vaginally. In this series there were 14 (10.8%) recorded complications with two (1.5%) major complications (95% confidence interval 0.2–5.5%). There was one bladder trauma (0.7%; 95% confidence interval 0.02–4.2%), which was recognised immediately and repaired with laparoscopic intracorporeal knots. One patient required additional vault sutures 6 h postsurgery because of vaginal bleeding. The mean operating time was 98.7 min, and the recorded mean hospital stay was 2.7 days, with a range of 2–5 days. The recorded estimated intraoperative blood loss ranged from 75 to 300 ml, with a mean loss of 195 ml, and four patients required blood transfusion. Dissection of the bladder laparoscopically adds 5–10 min to the operative time but significantly facilitates identifying the appropriate plane. It is an easy technique to learn and teach. It is associated with minimal complications, with no increased incidence of bladder injury or dysfunction.

Intrauterine Fetal Constraint Induces Chondrocyte Apoptosis and Premature Ossification of the Cranial Base

The spheno-occipital synchondrosis is an important growth center of the craniofacial skeleton and a primary site of malformation in syndromic forms of craniosynostosis. Clinical and laboratory investigations have demonstrated that premature closure of cranial vault sutures in nonsyndromic craniosynostosis is associated with characteristic alterations in cranial base morphology. However, a causal link between premature fusion of calvarial sutures and changes in the cranial base remains elusive. The purpose of these experiments was to test the hypothesis that intrauterine head constraint produces ultrastructural changes in the spheno-occipital synchondroses of fetal mice. Fetal constraint was induced through uterine cerclage of six pregnant C57Bl/6 mice on the eighteenth day of gestation. Fetuses were harvested after growing to 24, 48, and 72 hours beyond the normal 20-day gestational period. Between six and nine fetuses were harvested at all time points in both treatment and control groups. The morphology and cell biology of the spheno-occipital synchondroses, in constrained fetuses and unconstrained controls, were examined using hematoxylin and eosin-stained sections. Chondrocyte apoptosis was examined using terminal deoxynucleotidyl transferase-mediated dUDP end-labeling assays and electron microscopy. In nonconstrained animals, the spheno-occipital synchondrosis demonstrated normal architecture and normal chondrocyte morphology at all time points. In contrast, intrauterine constraint resulted in a progressive disruption of the normal cellular architecture of the spheno-occipital synchondrosis over 72 hours, with premature ossification of the synchondrosis. Widespread chondrocyte apoptosis within the synchondrosial growth center was demonstrated by terminal deoxynucleotidyl transferase-mediated dUDP end-labeling assays and electron microscopy. These experiments confirm the ability of intrauterine constraint to induce changes in the morphology and cell biology of the cranial base in synostotic fetuses.