Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy

OBJECTIVEOssification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance.METHODSThe authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO.RESULTSOssified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach.CONCLUSIONSThis study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.

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Developmental Considerations in Pediatric Skull Base Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1617449 ◽

2018 ◽

Vol 79 (01) ◽

pp. 003-012 ◽

Cited By ~ 5

Author(s):

Melissa LoPresti ◽

Jonathan Sellin ◽

Franco DeMonte

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Infratemporal Fossa ◽

Surgical Techniques ◽

Case Series ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Cancer Center ◽

Complication Rates ◽

Developmental Anatomy

Objectives To review developmental surgical anatomy and technical nuances related to pediatric skull base surgery. Design Retrospective, single-center case series with literature review. Setting MD Anderson Cancer Center. Participants Patients undergoing pediatric skull base surgery. Main Outcome Measures Review developmental anatomy of the pediatric skull base as it relates to technical nuance of various surgical approaches and insight gained from a 25-year institutional experience with this unique patient population. Results Thirty-nine patients meeting these criteria were identified over a 13-year period from 2003 to 2016 and compared to a previously reported earlier cohort from 1992 to 2002. The most common benign pathologies included nerve sheath tumors (11%), juvenile nasopharyngeal angiofibromas (9.5%), and craniopharyngiomas (4.8%). The most common malignancies were chondrosarcoma (11%), chordoma (11%), and rabdomyosarcoma (11%). Varied surgical approaches were utilized and were similar between the two cohorts save for the increased use of endoscopic surgical techniques in the most recent cohort. The most common sites of tumor origin were the infratemporal fossa, sinonasal cavities, clivus, temporal bone, and parasellar region. Gross total resection and postoperative complication rates were similar between the two patient cohorts. Conclusions Pediatric skull base tumors, while rare, often are treated surgically, necessitating an in depth understanding of the anatomy of the developing skull base.

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Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie ◽

10.1007/s00056-020-00276-w ◽

2021 ◽

Author(s):

Marcin Stasiak ◽

Anna Wojtaszek-Słomińska ◽

Bogna Racka-Pilszak

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Contralateral Side ◽

Cone Beam ◽

Rank Test ◽

Cross Sectional ◽

Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

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TOMOGRAPHIC MORPHOLOGICAL STUDY OF THE CRANIUM AND ITS CORRELATION WITH CRANIAL HALO USE IN ADULTS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501168033 ◽

2017 ◽

Vol 25 (1) ◽

pp. 11-14

Author(s):

TIAGO FERREIRA DE ALMEIDA ◽

HOMAR TOLEDO CHARAFEDDINE ◽

FERNANDO FLORES DE ARAÚJO ◽

ALEXANDRE FOGAÇA CRISTANTE ◽

RAPHAEL MARTUS MARCON ◽

...

Keyword(s):

Computed Tomography ◽

Morphological Study ◽

Descriptive Analysis ◽

Parietal Bone ◽

Frontal Bone ◽

Ct Scans ◽

Level Of Evidence ◽

Cross Sectional ◽

Significant Difference ◽

Parietal Bones

ABSTRACT Objective: To evaluate using tomographic study the thickness of the cranial board at the insertions points of the cranial halo pins in adults Methods: This is a retrospective, cross-sectional, descriptive analysis of Computed Tomography (CT) scans of adult patients' crania. The study included adults between 20 and 50 years without cranial abnormalities. We excluded any exam with cranial abnormalities Results: We analyzed 50 CT scans, including 27 men and 23 women, at the original insertion points and alternative points (1 and 2 cm above the frontal and parietal bones). The average values were 7.4333 mm in the frontal bone and 6.0290 mm in the parietal bone Conclusion: There was no statistically significant difference between the classical and alternative points, making room for alternative fixings and safer introduction of the pins, if necessary. Level of Evidence II, Retrospective Study.

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Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India

Asian Spine Journal ◽

10.4184/asj.2017.11.5.694 ◽

2017 ◽

Vol 11 (5) ◽

pp. 694-699 ◽

Cited By ~ 1

Author(s):

Venkatraman Indiran ◽

Vadivalagianambi Sivakumar ◽

Prabakaran Maduraimuthu

Keyword(s):

Computed Tomography ◽

Indian Population ◽

Normal Population ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Ct Scans ◽

Type I ◽

Cross Sectional ◽

Ethnic Populations ◽

The Mean

<sec><title>Study Design</title>A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population.</sec><sec><title>Purpose</title>There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population.</sec><sec><title>Overview of Literature</title>Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations.</sec><sec><title>Methods</title>A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type.</sec><sec><title>Results</title>Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females.</sec><sec><title>Conclusions</title>Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.</sec>

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Coronal Shear Fractures of the Distal Humerus

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk7010007 ◽

2022 ◽

Vol 7 (1) ◽

pp. 7

Author(s):

Enrico Bellato ◽

Riccardo Giai Via ◽

Daniel Bachman ◽

Ilaria Zorzolo ◽

Antonio Marmotti ◽

...

Keyword(s):

Computed Tomography ◽

Treatment Options ◽

The Elderly ◽

Distal Humerus ◽

Ct Scans ◽

Surgical Approaches ◽

Decision Making Process ◽

Common Complication ◽

Comminuted Fractures ◽

Diagnosis Classification

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

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Pediatric Skull Base Tumors

10.5772/intechopen.95605 ◽

2021 ◽

Author(s):

Usman A. Khan ◽

Jillian H. Plonsker ◽

Robert C. Rennert ◽

Michael L. Levy

Keyword(s):

Quality Of Life ◽

Skull Base ◽

Neurofibromatosis Type ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Skull Base Tumors ◽

Tumor Pathology ◽

Neuro Imaging ◽

Individualized Management

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.

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Anatomical and Radiological Study of Jugular Foramen

National Journal of Clinical Anatomy ◽

10.1055/s-0039-1700309 ◽

2019 ◽

Vol 08 (03) ◽

pp. 121-125

Author(s):

Ajay Kumar ◽

Alok Tripathi ◽

Shobhit Raizaday ◽

Shilpi Jain ◽

Satyam Khare ◽

...

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Skull Base ◽

Jugular Foramen ◽

Ct Scans ◽

Transverse Diameter ◽

Radiological Study ◽

Significant Difference ◽

Human Skulls ◽

The Right

Abstract Background and Aim The purpose of present study was to obtain comprehensive data of morphometric and anatomical details of jugular foramen. Materials and Methods The study was performed on 30 dry adult human skulls along with computed tomography (CT) scans from 30 adult patients. The parameters observed were dimensions, shape, margins, confluence, septations, and distance from jugular foramen to mastoid base. Result In the dry skull observations, only anteroposterior diameter (APD) was significantly different between the right and left side, while for the CT scan observations both transverse diameter and APD exhibit significant difference. Conclusion We believe that data from the present study will help radiologists and neurosurgeons for diagnosis and treatment of skull base pathology around jugular foramen.

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Imaging the Cerebrovascular Tree in the Cadaveric Head for Planning Surgical Strategy

Neurosurgery ◽

10.1097/00006123-200211000-00018 ◽

2002 ◽

Vol 51 (5) ◽

pp. 1222-1228 ◽

Cited By ~ 8

Author(s):

Jin-Cheng Zhao ◽

Chi Chen ◽

Sami S. Rosenblatt ◽

Joel R. Meyer ◽

Robert R. Edelman ◽

...

Keyword(s):

Computed Tomography ◽

Contrast Agent ◽

Skull Base ◽

Surgical Planning ◽

Soft Tissues ◽

Three Dimensional ◽

Surgical Anatomy ◽

Vascular Lesions ◽

Preoperative Imaging ◽

Computed Tomographic

Abstract OBJECTIVE The objective of the study was to identify whether an integration of cadaveric dissections with preoperative imaging information may enable a better understanding of pathological anatomy, especially vascular lesions, and thus allow for greater precision in surgical planning. METHODS We selected a computed tomographic contrast agent and experimentally determined the proportion of it that could mix compatibly with the silicone compound. The resultant mixture was injected into the cerebrovascular systems of six fresh human cadaveric heads. The specimens underwent computed tomography for the purpose of digital virtual exposures in parallel with laboratory dissections performed on these specimens. RESULTS The 1:8 ratio of contrast agent to silicone rubber was determined to be appropriate for both computed tomography and subsequent laboratory dissection of the specimens. The blood vessels in computed tomographic scans demonstrated a higher attenuation than surrounding soft tissues. The opacity consistency of the injected vessels was a critical parameter for a clear three-dimensional rendering of the vascular structures in the natural surroundings of the skull base. Static and dynamic three-dimensional images of the cadaveric vascular tree were obtained as viewed through surgical corridors of various skull base approaches. CONCLUSION We demonstrated a new cadaveric preparation model for imaging and dissection. This model allows for static and dynamic three-dimensional examination of the surgical anatomy from a neurosurgeon's perspective. It may facilitate the study of cerebrovascular system morphology/pathology in relation to the skull base as a tool for surgical planning.

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Radiological Correlation between Pneumatization of Frontal Sinus and Height of Fovea Ethmoidalis

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3072 ◽

2007 ◽

Vol 21 (5) ◽

pp. 626-628 ◽

Cited By ~ 6

Author(s):

Cesur Gumus ◽

Altan Yildirim

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Skull Base ◽

Frontal Sinus ◽

Ct Scans ◽

The Relationship

Background We need more data about the variations of skull base to minimize the complications of ethmoidectomy. The aim of this study was to analyze the relationship between the pneumatization of the frontal sinus and height of the fovea ethmoidalis. Methods Paranasal coronal computed tomography (CT) scans of 487 sides of 300 patients were evaluated. The presence of the frontal cell and pneumatization of the frontal sinus were studied with respect to the height of the fovea ethmoidalis. Results We found a statistically significant correlation between the frontal cell and frontal sinus hyperpneumatization (p = 0.000). We determined that there was a deeper fovea ethmoidalis in the sides that have a frontal cell (p ≤ 0.001) and in the sides that have hyperpneumatization of the frontal sinus (p = 0.000). We also observed flatter fovea ethmoidalis in the sides that have hypopneumatization of the frontal sinus (p ≤ 0.001). Conclusion The presence of a frontal cell or hyperpneumatization of the frontal sinus on CT scan should alert the clinician that there may be a deep fovea ethmoidalis.

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