Multiple Myeloma Involving Left Hemicranium

Multiple myeloma (MM) is a malignant neoplasm of bone marrow affecting plasma cells. It is commonly seen as multiple punched-out lesions in the skull bone as a characteristic feature. Its presentation as hemicranial involvement with intracranial extension is rare. A 46-year-old male presented with left side scalp swelling, prominent over parietal region. X-ray showed multiple punched out lesions involving left hemicranium. CT and MRI brain showed intracranial extension of lesion without brain parenchyma invasion. He was treated with biopsy of lesion followed by chemotherapy.

High Precision Bone Cutting by Er: YAG Lasers Might Minimize the Invasiveness of Navigated Brain Biopsies

Biopsies of brain tissue are sampled and examined to establish a diagnosis and to plan further treatment, e.g. for brain tumors. The neurosurgical procedure of sampling brain tissue for histologic examination is still a relatively invasive procedure that carries several disadvantages. The “proof of concept”-objective of this study is to answer the question if laser technology might be a potential tool to make brain biopsies less invasive, faster and safer. Laser technology might carry the opportunity to miniaturize the necessary burr hole and also to angulate the burr hole much more tangential in relation to the bone surface in order to take biopsies from brain regions that are usually only difficult and hazardous to access. We examined if it is possible to miniaturize the hole in the skull bone to such a high extent that potentially the laser-created canal itself may guide the biopsy needle with sufficient accuracy. The 2-dimensional, i.e. radial tolerance of the tip of biopsy needles inserted in these canals was measured under defined lateral loads which mimic mechanical forces applied by a surgeon. The canals through the skull bones were planned in angles of 90° (perpendicular) and 45° relative to the bone surface. We created a total of 33 holes with an Er : YAG laser in human skull bones. We could demonstrate that the achievable radial tolerance concerning the guidance of a biopsy needle by a laser created bone canal is within the range of the actual accuracy of a usual navigated device if the canal is at least 4 mm in length. Lateral mechanical loads applied to the biopsy needle had only minor impact on the measurable radial tolerance. Furthermore, in contrast to mechanical drilling systems, laser technology enables the creation of bone canals in pointed angles to the skull bone surface. The latter opens the perspective to sample biopsies in brain areas that are usually not or only hazardous to access.

Dental Anthropology-A Revolutionary Tool in Forensic Science

Dental anthropology is a field of physical anthropology that studies the origin, development, and evolution of anthropoid dentitions, as well as their relationship to social, physical, and cultural factors. Teeth have their own distinct morphology and physiology, which is in stark contrast to the body's genetic structure. Teeth are also unique among the resistant elements of archaeological and fossil remains in that they have been exposed on the body's surface throughout their lives. As a result, dental anthropology may be assessed in the mouth cavity of living humans using similar methods to those used for prehistoric relics. As a result, it's no surprise that practising dental surgeons have historically ranked well among dental anthropologists. This review’s initial purpose is to provide an overview of the morphological and non-morphological properties of animate dentitions that aid in the indirect identification of prehistoric remains and the understanding of their cultural, social, and physical relationships, as well as to assist forensic odontologists with craniofacial identification and skull bone reconstruction.

Frontal swelling – An unusual presentation of sarcoidosis: A case report

Subcutaneous sarcoidosis is a rare, cutaneous expression of systemic sarcoidosis. It is observed as asymptomatic firm, nodules covered by normal-appearing skin, principally on the extremities, which show the typical histopathology appearance of non-caseating granulomas localized to the subcutaneous tissue. It may be associated with the early benign, hilar lymphadenopathy of sarcoidosis or with the later stages of progressive sarcoidosis. Here, we report a case of subcutaneous sarcoidosis, which presented as an asymptomatic, forehead swelling with involvement of skull bone and lung. We report this case since subcutaneous sarcoidosis on the face with involvement of skull bone is a rarity.

Skull Thickness Calculation Using Thermal Analysis and Finite Elements

In this study, the skull bone thicknesses of 150 patients ranging in age from 0 to 72 years were calculated using a novel approach (thermal analysis), and thickness changes were analyzed. Unlike conventional thickness calculation approaches (Beam Propagation, Hildebrand), a novel heat transfer-based approach was developed. Firstly, solid 3D objects with different thicknesses were modeled, and thermal analyses were performed on these models. To better understand the heat transfer of 3D object models, finite element models (FEM) of the human head have been reported in the literature. The FEM can more accurately model the complex geometry of a 3D human head model. Then, thermal analysis was performed on human skulls using the same methods. Thus, the skull bone thicknesses at different ages and in different genders from region to region were determined. The skull model was transferred to ANSYS, and it was meshed using different mapping parameters. The heat transfer results were determined by applying different heat values to the inner and outer surfaces of the skull mesh structure. Thus, the average thicknesses of skull regions belonging to a certain age group were obtained. With this developed method, it was observed that the temperature value applied to the skull was proportional to the thickness value. The average thickness of skull bones for men (frontal: 7.8 mm; parietal: 9.6 mm; occipital: 10.1 mm; temporal: 6 mm) and women (frontal: 8.6 mm; parietal: 10.1 mm; occipital: 10 mm; temporal: 6 mm) are given. The difference (10%) between men and women appears to be statistically significant only for frontal bone thickness. Thanks to the developed method, bone thickness information at any desired point on the skull can be obtained numerically. Therefore, the proposed method can be used to help pre-operative planning of surgical procedures.

Genome Wide Association Metanalysis Of Skull Bone Mineral Density Identifies Loci Relevant For Osteoporosis And Craniosynostosis

Skull bone mineral density (SK-BMD) provides a suitable trait for the discovery of genes important to bone biology in general, and particularly for identifying components unique to intramembranous ossification, which cannot be captured at other skeletal sites. We assessed genetic determinants of SK-BMD in 43,800 individuals, identifying 59 genome-wide significant loci (4 novel), explaining 12.5% of its variance. Pathway and enrichment analyses of the association signals resulted in clustering within gene-sets involved in regulating the development of the skeleton; overexpressed in the musculoskeletal system; and enriched in enhancer and transcribed regions in osteoblasts. From the four novel loci (mapping to ZIC1, PRKAR1A, ATP6V1C1, GLRX3), two (ZIC1 and PRKAR1A) have previously been related to craniofacial developmental defects. Functional validation of skull development in zebrafish revealed abnormal cranial bone initiation that culminated in ectopic sutures and reduced BMD in mutated zic1 and atp6v1c1 fish and asymmetric bone growth and elevated BMD in mutated prkar1a fish. We confirmed a role of ZIC1 loss-of-function in suture patterning and discovered ATP6V1C1 gene associated with suture development. In light of the evidence presented suggesting that SK-BMD is genetically related to craniofacial abnormalities, our study opens new avenues to the understanding of the pathophysiology of craniofacial defects and towards the effective pharmacological treatment of bone diseases.

Common Patterns of Skull Bone Fusion and Their Potential to Discriminate Different Ontogenetic Stages in Extant Birds

The degree of sutural closure between bones generally allows for the classification of skeleton maturity in tetrapods. In mammals, the sutural closure of skull bones was previously used as proxy to evaluate the ontogenetic stage of single individuals. However, due to temporal variation, this process can be only applied among mammalian subclades, but not for all mammals in general. In contrast, the process of sutural closures in bird skulls could be a more reliable ontogenetic proxy for this clade as adult birds commonly show a generally high degree of bone fusion. To test this, we studied the process of sutural closure in ontogenetic series of 18 extant bird species regarding the presence of an ontogenetic signal and compared the results with changes in skull size and proportions. Univariate analyses indicate that bone fusion happens faster in altricial than in precocial birds. However, the use of PCoA and multivariate regressions reveal that the skull bone fusion follows a common pattern among birds and thus can be used as proxy to identify different ontogenetic stages. In general, the process of sutural closure spreads from posterior to anterior and from ventral to dorsal. In contrast, skull measurements reflect rather interspecific allometry than ontogeny. The used of bone fusion as proxy will help to better identify and compare different stages of maturation in birds, including historical material from osteological collections.

Simulation study on the effects of cancellous bone structure in the skull on ultrasonic wave propagation

The transcranial Doppler method (TCD) enables the measurement of cerebral blood flow velocity and detection of emboli by applying an ultrasound probe to the temporal bone window, or the orbital or greater occipital foramina. TCD is widely used for evaluation of cerebral vasospasm after subarachnoid hemorrhage, early detection of patients with arterial stenosis, and the assessment of brain death. However, measurements often become difficult in older women. Among various factors contributing to this problem, we focused on the effect of the diploe in the skull bone on the penetration of ultrasound into the brain. In particular, the effect of the cancellous bone structure in the diploe was investigated. Using a 2D digital bone model, wave propagation through the skull bone was investigated using the finite-difference time-domain (FDTD) method. We fabricated digital bone models with similar structure but different BV/TV (bone volume/total volume) values in the diploe. At a BV/TV of approximately 50–60% (similar to that of older women), the minimum ultrasound amplitude was observed as a result of scattering and multiple reflections in the cancellous diploe. These results suggest that structural changes such as osteoporosis may be one factor hampering TCD measurements.

Cerebrospinal fluid outflow through skull channels instructs cranial hematopoiesis

Interactions between the immune and central nervous systems strongly influence brain health. Although the blood-brain barrier restricts this crosstalk, we now know that meningeal gateways through brain border tissues, particularly dural lymphatic vessels that allow cerebrospinal fluid outflow, facilitate intersystem communication. Here we observe that cerebrospinal fluid exits into the skull bone marrow. Fluorescent tracers injected into the cisterna magna of mice travel through hundreds of sub-millimeter skull channels into the calvarial marrow. During meningitis, bacteria usurp this perivascular route to infect the skull's hematopoietic niches and initiate cranial hematopoiesis ahead of remote tibial sites. Because skull channels also directly provide leukocytes to meninges, the privileged sampling of brain-derived danger signals in cerebrospinal fluid by regional marrow has broad implications for neurological disorders.