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Penetrating brain injuries are rare events in modern times. In this article we present the case of an adolescent with a knife, lodged in the occipital region needing surgical care. The patient was conscious, cooperative, and vitally stable with a Glasgow coma scale (GCS) of 15/15 with no lateralizing signs. Computed tomography (CT) scan of the brain demonstrated the knife blade in the suboccipital bone with suspicious injury to the right transverse sinus. General anesthesia was provided and airway secured in a lateral position using a video laryngoscope. Surgery was performed in the prone position using the Mayfield head holder. All measures to prevent secondary brain injury were taken. The patient remained vitally stable during surgery and could be extubated after surgery. Planning and preparation are vital for the smooth conduct of the case. [ABSTRACT FROM AUTHOR]

Variations of the skull base can affect surgical approaches and must be considered when viewing and interpreting radiological imaging. Here, we report a unique collection of bony anatomical variations found on a single adult skull. Three bony excrescences from the occipital bone were identified in the paracondylar region. The smallest of these processes was 7 mm long and was just medial to the mastoid process of the temporal bone and posterior to the styloid process. One bony process was attached to the occipital condyle and was 12 mm in length. The longest of these processes was 17 mm long and arose from the jugular process of the occipital bone. Paracondylar processes can be symptomatic. Knowledge of the bony variations at the skull base is important to those who operate in this region or review and interpret radiological imaging. [ABSTRACT FROM AUTHOR]

Introduction: Jugular foramen is a complex irregular bony canal located at the base of the skull between the condylar part of occipital bone and petrous part of temporal bone. It allows passage of important nervous and vascular structures. These are ninth, tenth, eleventh cranial nerves, sigmoid sinus continued as the superior bulb of internal jugular vein and inferior petrosal sinus, meningeal branches of the ascending pharyngeal and occipital arteries. Jugular fossa has a septum and a dome. The dome lodges the superior bulb of internal jugular vein. The septum divides the foramen into two compartment, antero- medial and postero-lateral. There is a wide variation in shape, size and septation of jugular foramen in different regions of globe which have been studied by different authors in different periods of time. Many tumours may arise in this region causing compression of the vital structures passing through it. Surgery is the treatment of choice in these cases. Successful neuro surgeries involving this region require detailed knowledge about the anatomical variation of the jugular foramen. Aim: To study and compare the morphology of jugular foramen, its various dimensions, shape, size and septation and its clinical significance related to internal jugular vein. Materials and Methods: A cross-sectional descriptive study was carried out on 85 adult dry human skulls, collected from the Anatomy Department as well as from the first year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of different Medical colleges of West Bengal from September 2020 to June 2021. Presence of septa were observed and anteroposterior (AP), mediolateral diameter (ML diameter) were measured by using vernier calliper. Then the area was calculated. Data collected were compiled in tabular form. They were analysed by using Statistical Package for Social Sciences (SPSS) statistics version 20.0 and paired t-test and chi-square tests were applied. Results: In the total 85 skulls studied, the area of jugular foramen was larger on right side in 91.76% and on left side in 8.24% of skull. The AP diameter was less than the ML diameter and areas in all cases. But both the diameters were significantly (p-value

Objective: To determine the morphometric parameters of the occipital condyle (OC) in adult Nigerians using computed tomography (CT). Methods: Following ethical approval, the morphometric parameters of the OC of 336 adult Nigerians (199 males, 137 females) aged .20 years were measured on brain CT images stored at the Radiology Department of a tertiary hospital. Results: Males had significantly larger metric parameters than females. The measurements showed significant differences in the various 10 years' age groups. The width, and distance from anterior tips to basion, and opisthion showed significant side differences. There was a significant positive correlation between the right, and left OC morphometric parameters (P<0.05). Conclusion: The morphometry of the OC in the studied population differed from previous literature reports. Therefore, consideration of population specific morphometry is paramount for safe craniovertebral junction surgeries and in the design of customised OC implants. [ABSTRACT FROM AUTHOR]

Background: Adult type fibrosarcoma is a rare and highly aggressive type of soft tissue tumor. Surgical resection with wide margins is the most effective, but difficult for the skull lesion as to the critical organ nearby. Case description: A 27-year-old Japanese woman presented a occipital tumor progressively enlarging for 2 months. CT scan showed an ovoid mass with osteolysis, extending to intracranially and subcutaneous tissue. MRI revealed the tumor involved transverse and sigmoid sinus. The gross total resection was achieved with mastoidectomy. The skull was reconstructed by titanium plate and bone cement. The proton beam irradiated after surgery. Chemotherapeutic agents were not administrated. Single lung metastasis was evident after 1 year later and removed. The patient is good in health at 8 years after initial diagnosis and got a baby. Conclusion: Skull high grade fibrosarcoma was successfully treated by entire surgical removal with proton beam therapy.

Desmoplastic fibroma is a primary locally aggressive bone tumor which is exceedingly rare in the cranial bones. We report the first case of occipital bone desmoplastic fibroma. A 33-year-old female patient, presented with swelling over her occiput, started to enlarge progressively two years ago. Brain CT showed right occipital extracranial lesion of heterogenous density, based on the outer table with underlying bone sclerosis. Patient operated with complete excision and curettage of the involved skull bone. Histopathological examination reported the lesion as desmoplastic fibroma.

Background: Unilateral coronal synostosis causing anterior plagiocephaly can result in restricted brain development and severe facial deformities. Various surgical procedures have been described for the correction of this deformity. Cranial vault remodeling, however, is associated with several complications. Occipitofrontal switching is a novel technique which utilizes a part of the contralateral occipital bone to reconstruct the frontal area. This is the first such case reported from India and first report where virtual mock surgery has been utilized for precision and improving outcome in this elegant procedure. Case Description: A 5-year-old girl presented with left anterior plagiocephaly. 3D image of her skull was reconstructed using Geomagic Freeform software (3D Systems, Rock Hill, SC). Measurements were accurately drawn and the procedure was practised virtually before performing the occipitofrontal switch on the patient. The re were minimal blood loss and postoperative morbidity. One year follow-up of the patient showed optimal correction of the defect in the forehead region, symmetrical shape of the frontal and occipital region and symmetrical brows. Conclusion: The technique of occipitofrontal switch for correction of anterior plagiocephaly is an elegant procedure with good functional and aesthetic outcome. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: The occipital bone in the human skull consists of two parts -supraoccipital and interparietal part. Sometimes the interparietal portion of the occipital bone remains separated from the supraoccipital part by a transverse suture, resulting in the occurrence of inca bone. Sometimes in man, interparietal bone is seen as a separate bone, as a variant. Aim: To study the incidence of inca bone and its variations in dry human skull bones. Materials and Methods: The present osteological study was done on 230 dry human skulls taken by convenient sampling method, of both the sex and of all the age groups during one year period from August 2018 to August 2019. The skull bones were collected from Anatomy and Forensic medicine departments of five medical colleges, both government and private medical colleges, in Krishna district, Andhra Pradesh, Southern India. Inferential statistics in terms of simple percentages were used. Results: Among the 230 skull bones, 6 (2.6%) skulls were seen with inca bones. Out of these six skulls with interparietal bone, two skulls showed complete undivided inca bone. Incidence of inca bone was higher in male (3.4%) skull bones when compared to female (1.2%) skulls. Conclusions: This inca bone incidence varies among different population. The knowledge about these inca bones would be useful to Clinicians, Radiologists and Neurosurgeons during their case management, besides the Forensic experts during their medicolegal case examinations.

Aim: The causes of the syringomyelia in Chiari are not certainly defined. We have done morphometric analyses which can be useful to understand natural course and causes which increase the surgery requirement of patients. Methods: Eighty nine patients (operated) and 41 patients (non-operated) were included the study. Investigations were done as randomized. Accompanying syringomyelia, area of foramen magnum, herniated tonsil volume and clivo-dental angle were compared between operated and control groups. Results: Syringomyelia was seen in 50%. The mean values of FMA were 765.2±119.5 mm². The mean value of critical discourse analysis (CDA) was 139.5±10.6°. Mean of the hydrophobicity (HTV) were found to be 54.5±24.1 mm³. The mean of age was 27±11.1, FMA was 876.5±131.9 mm², CDA was 141.1±10.2° and HTV was 57.6±20.7 mm³ in the patients with syringomyelia. The mean of age was 33.9±12, FMA was 704.3±99.6 mm², CDA was 137,8±10,8° and HTV was 51,4±26,8 mm³ in the patients who had not syringomyelia. Conclusion: Younger age, larger FMA and CDA increase the HTV and the rate of accompanying syringomyelia. As a result, the need for surgery increases. We think that it may be beneficial to consider these parameters in patients who are evaluated for surgery. [ABSTRACT FROM AUTHOR]

Ectopic cerebellar tissue has only been described in isolated case reports, with only two reported cases in adult patients. We report the case of a 63-year-old woman with progressive, medically refractory headaches. A scan showed an intraosseous lesion of the midline occipital bone. Surgical resection of the soft tissue lesion was undertaken. Her headaches ceased postoperatively. Histopathological analysis revealed cerebellar cortical tissue with a surrounding meningothelial cell layer, characteristic of cerebellar ectopia. This is the second reported case of an intraosseous location of this lesion, and only the third case described in an adult patient. Our findings illustrate a rare cause of headaches and support the therapeutic roles of surgical treatment for this extremely rare condition.

Introduction: Foramen Magnum (FM) is present at the lower part of the occipital bone. It is a very important landmark for the anthropology, anatomy, forensic medicine, surgeons and other medical field for the skull base. Aim: To observe the shape of foramen magnum and to measure the various morphometric parameters. Materials and Methods: Morphological and morphometric study was done on 120 dry human skulls. Digital Vernier caliper was used for measurement. The shape of foramen magnum was noted and classified as oval, round, tetragonal, pentagonal, hexagonal and irregular in shape. Morphometric measurements like anterio-posterior diameter, transverse diameter were measured and Foramen magnum index was calculated. Statistical analysis was done and minimum, maximum mean and standard deviation was calculated. Results: The most common shape of FM was oval in 40 (33.3%) skulls; followed by tetragonal in 20 (16.6%) skulls and hexagonal in 20 (16.6%) skulls. Round shaped FM was present in 16 (13.3%) skulls, pentagonal FM in 16 (13.3%) and pear shaped FM was present in 8 (6.6%) skulls.The mean of Anteroposterior (AP) diameter was 33.79±2.60 mm; transverse diameter was 28.25±1.83 mm and foramen magnum index was 83.91±6.43. Conclusion: The Knowledge of size and shape of foramen magnum is helpful to neurosurgeons in cranio-vertebral surgical approaches as well as in posterior cranial fossa surgeries. Data of present study may be helpful to neurosurgeons, anthropologist or forensic persons.

Giant cell tumors of the bone are rare lesions that primarily affect the epiphyses of long bones. They represent 3 to 7% of primitive bone tumors. These tumors are exceptional in the skull and affect mainly the sphenoid and the temporal bones. These lesions are usually benign as well as locally agressive and require complete removal. We report a case of giant cell cyst of the skull involving the cranial vault in a 20-year-old woman presented with localized, non tender, fixed right occipito-cervical mass. Her physical exam revealed a cerebellar syndrom. A computed tomography (CT) scan showed a lytic extensive extraaxial lesion involving the right occipital bone and expanding into the posterior fossa. The patient underwent a right occipital craniectomy with resection of the bone and the epidural mass followed by an artificial bone reconstruction (methyl methacrylate cement). Histopathologic analysis revealed a giant cell tumor. Post-operative course was uneventful. No local recurrence was observed after 3 years follow-up. Giant cell tumors are generally benign, locally aggressive lesions with a high rate of local recurrence. Total surgical excision is the treatment of choice. This report contributes to the litterature of giant cell tumor of the skull, especially the posterior fossa and the method of surgical intervention used for treatment. The place of the adjuvent therapy remains controversial. [ABSTRACT FROM AUTHOR]

This study aimed to summarize the clinical features, diagnosis, and treatment of Chiari malformation type I- (CM-1-) associated syringobulbia. We performed a literature review of CM-1-associated syringobulbia in PubMed, Ovid MEDLINE, and Web of Science databases. Our concerns were the clinical features, radiologic presentations, treatment therapies, and prognoses of CM-1-associated syringobulbia. This review identified 23 articles with 53 cases. Symptoms included headache, neck pain, cranial nerve palsy, limb weakness/dysesthesia, Horner syndrome, ataxia, and respiratory disorders. The most frequently involved area was the medulla. Most of the patients also had syringomyelia. Surgical procedures performed included posterior fossa decompression, foramen magnum decompression, cervical laminectomy, duraplasty, and syringobulbic cavity shunt. Most patients experienced symptom alleviation or resolution postoperatively. A syringobulbic cavity shunt provided good results in refractory cases. Physicians should be aware of the possibility of syringobulbia in CM-1 patients, especially those with symptoms of sudden-onset brain-stem involvement. The diagnosis relies on the disorder's specific symptomatology and magnetic resonance imaging. Our review suggests that the initial therapy should be posterior fossa decomposition with or without duraplasty. In refractory cases, additional syringobulbic cavity shunt is the preferred option. [ABSTRACT FROM AUTHOR]

Objective  Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design  Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting  University of California Davis Medical Center (2010–2016). Participants  A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair. Exclusion criteria included patients who were under the age of 18 years. Main Outcome Measures  Main outcomes included incidence of postoperative headache, cerebrospinal fluid leak, and wound infections. Results  Postoperative headache was reported in two patients in this series (8%). None of the patients in the series developed cerebrospinal fluid leak or wound infections. Mean follow-up period was 16 months. Conclusion  Our multilayered anatomic repair after retrosigmoid suboccipital craniotomy results in favorable clinical results and may help reduce the risks associated with this operation. [ABSTRACT FROM AUTHOR]

Background: Ewing's sarcoma is a disease of children and young adults and occurs most often in bone and soft tissues. The intracranial and spinal manifestation of the disease is rare and reported incidence is 1%–6%. Aims and Objectives: We conducted this study to determine the surgical outcome of children with skull and spine Ewing's sarcoma (SSES). Methods: This is a prospective analysis of 13 patients of SSES who reported to the Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India, between 2014 and 2016. All cases after detailed examination, magnetic resonance imaging, and computed tomography scan were subjected to surgery followed by adjuvant therapy comprising chemotherapy and radiotherapy. Outcome was analyzed at 6 months as well at latest follow-up. Neurological function, local recurrence, primary or secondary nature of the disease, distant relapse, and treatment-related complications were analyzed in this study. Results: There were eight female and five male patients with a mean age of 12 years (ranging from 4 to 8 years). Pain was the common presenting feature in all cases. Focal neurological deficits corresponding to the anatomical location was seen in six patients. These 13 cases were distributed anatomically as four cases involving the cloves, two cases with occipital bone and lobe involvement, one case of parietal bone and lobe involvement, and six cases of spinal involvement. Surgery was performed in all cases where gross total excision (Ozge C, Calikoglu M, Cinel L, Apaydin FD, Ozgür ES. Massive pleural effusion in an 18-year-old girl with Ewing sarcoma. Can Respir J 2004;11:363-5), near-total excision, and subtotal excision was achieved in these 13 cases (Steinbok P, Flodmark O, Norman MG, Chan KW, Fryer CJ. Primary Ewing's sarcoma of the base of the skull. Neurosurgery 1986;19:104-7). Subsequently all cases underwent multiagent chemoradiotherapy. Postsurgery pain subsided in 12 (92%) of patients. Ten patients maintained or improved motor function. In seven cranial cases and in six spinal cases, four cases showed improvement whereas three (23%) had deterioration of motor function. Conclusions: Surgical outcome of SSES in short-term follow-up is good with current recommended management regimen of maximum excision followed by chemo and radiotherapy. However, metastasis is not uncommon. [ABSTRACT FROM AUTHOR]

Abstract Introduction Suboccipital muscle involvement in a plasmacytoma of occipital bone is a rare clinical event. It leads to a dilemma of categorizing it into either Solitary plasmacytoma or extra medullary plasmacytoma. A working protocol is necessary to follow up these patients to detect their progression into multiple myeloma. Clinical Presentation A 38-year-old man presented with a progressively increasing hard swelling in the occipital region of five years duration. Brain CT revealed an osteolytic SOL over the torcula extending up to the foramen magnum. Brain MRI revealed an extraxial lesion. Brain MRV revealed no involvement of the torcula. Skeletal survey for metastasis was normal. After evaluation, we performed a surgical excision of the lesion. Intraoperatively, the tumor had invaded the suboccipital muscles and parietal bone and was adherent to the dura, without any intracranial extension. Histopathology reported Plasmacytoma. Immunohistochemical analysis was positive for CD-138. Bone marrow biopsy was negative for plasma cells. Bence Jones protein was absent and M protein absent in serum electrophoresis. USG abdomen normal. The patient underwent radiotherapy and is under continuous follow-up. Conclusion Plasmacytoma of occipital bone with suboccipital muscles involvement is categorized as Solitary Plasmacytoma of the bone. This provides convenience in diagnosis, management, and follow-up. We report on this case for its rarity in presentation. The protocol followed in our institute, based on our experience with such tumors, will aid in early identification of the progression of solitary plasmacytoma of bone into multiple myeloma and will augment prompt management.

Objective : Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. Methods : A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation.The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery. Results : In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound.When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system.Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. Conclusion : We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density. [ABSTRACT FROM AUTHOR]

Skeletal dysplasias are a large group of rare diseases, with over 400 distinct entities recognised. Diagnosis is challenging, largely reflecting the rareness of individual conditions; yet collectively these disorders affect as many as 1:3000 individuals. The phenotypic diagnosis of skeletal dysplasia is based on careful clinical evaluation and, critically, on assessment of radiological appearances of the skeleton, which in most cases requires specialist expertise. Powerful modern genetic testing is transforming the approach to diagnosis of rare genetic disease, but does not obviate the need for accurate clinical and radiological evaluation. Management of children with skeletal dysplasias must pay attention to detection and prevention of potentially severe complications, particularly those involving compromise of the central nervous system, such as foramen magnum narrowing or atlanto-axial subluxation. Surgical management aims to treat these complications, but can also enhance function and in some cases address short stature. Targeted molecular treatments are emerging with potential to reverse these disorders, and are already transforming the lives of some children with debilitating diseases. We discuss 5 skeletal dysplasia conditions in more detail: Achondroplasia, Pseudoachondroplasia, Spondyloepiphyseal Dysplasia Congenita, Cartilage Hair Hypoplasia and Hypophosphatasia. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences. Method: a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data. Results: the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg). Conclusion: IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS. [ABSTRACT FROM AUTHOR]

Primary osteosarcomas of the skull and skull base are rare and comprise

Purpose: Recently, several authors have proposed techniques for improving the fusion rate in pediatric posterior occipitocervical fusion including a variety of implants and the use of bone morphogenetic protein. A technique by Koop et al. using a periosteal flap for occipitocervical arthrodesis was described in 1984.Methods: A straight incision is made about the posterior neck to expose the occipitocervical region from the inion superiorly to the lowest cervical vertebrae to be fused inferiorly. The occiput is exposed superficial to the periosteum, which is then reflected and elevated from the occiput. The attachment is preserved at the caudal base of the flap and reflected over the intended area of fusion. When possible, fixation is then performed with cables, wires, screws, hooks, or plates.Case Example: A 6-year-old male with an occiput to C2 distraction injury underwent posterior spinal fusion from occiput to C3 using sublaminar wires, periosteal turndown flap, and autologous iliac crest bone graft.Conclusion: In small children with traumatic upper cervical spine instability, the periosteal turndown technique may be used as a safe adjunct for occipitocervical fusions. [ABSTRACT FROM AUTHOR]

Background: Type I Chiari malformation presents without an associated hydromyelia in 30 to 70% of cases, yet there is no agreement regarding the optimal surgical treatment for these patients. We review our experience for treating symptomatic adult type I Chiari malformation without hydromyelia using a suboccipital bone decompression of the hindbrain and no duraplasty in 12 adult patients. Outcome was measured according to the Chicago Chiari Outcome Scale (CCOS). Results: Nine of 12 patients were female; average age at surgery was 34.4 years (range: 17-67 years). Average duration of symptoms prior to surgery was 9.6 years (2 months-29 years). The most common symptom was head and/or neck pain (11/12 patients). All patients additionally presented with at least one non-pain symptom. Mean degree of tonsillar herniation on magnetic resonance imaging was 6.8 mm (range: 5-12 mm) below McRae's line. Operative time was on average 68 minutes (range: 47-120 minutes). No surgical complications were noted in any patient. Length of hospital stay was 2 days (1 overnight) for all patients. Mean follow-up was 167 weeks (range: 13-378 weeks). CCOS for all patients on average was 14.50 (range: 12-16). Pain symptoms underwent improvement (7/11 [63.6%]) or complete resolution (4/11 [36.4%]) in all affected patients. A shorter duration of preoperative symptoms significantly correlated with a better CCOS (p = 0.03). Degree of tonsillar herniation had no significant effect on CCOS (p = 0.67). Of non-pain symptoms, paresthesias/dysesthesias and visual symptoms improved or resolved completely in all affected patients. No patient experienced a worsening of either pain or non-pain symptoms. Conclusion In the subset of adult patients with a type I Chiari malformation and no associated hydromyelia, a craniectomy without an additional opening of the dura may achieve good overall results according to the CCOS. [ABSTRACT FROM AUTHOR]

Objective We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results. Methods From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C 2 pedicle at our department. All patients underwent “posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C 2 and lateral mass of C 3 on the narrowed C 2 pedicle side—for non-narrowed C 2 pedicle side, the screw was only inserted into C 2 pedicle without extending the fixation to C 3 vertebrae—using a titanium screw-rod (plate) fixation system.” The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy. Results A total of 134 screws were inserted into the C 2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C 2 , and lateral mass of C 3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions ( P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion. Conclusion This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C 2 pedicle. [ABSTRACT FROM AUTHOR]

Background: Meningiomas of the craniovertebral junction are complex lesions representing a neurosurgical challenge. The aim of the study is to describe the technique of a posterolateral approach and results in a series of patients with meningiomas of the foramen magnum and the first two cervical vertebrae. This posterior approach route with individualized lateral extension could be a safe technique in terms of morbidity and mortality compared to other approaches for this type of tumors. Material and methods: Sixteen consecutive patients diagnosed with meningioma of the foramen magnum and / or the first 2 cervical vertebrae (C1- C2) were treated. Resection of the lesion was performed through a posterior midline corridor with a suboccipital craniectomy of 3 cm with opisthion resection and posterior arch of C1 and according to intraspinal extension, spinous process of C2. For meningiomas of the foramen magnum a side drilling was performed towards the condyle, without altering the latter; while in meningiomas of C1-C2 arches of C1 and C2 were drilled having the lateral masses as a limit. Results: Gross total resection of the lesion was achieved in all patients treated with a minimum recurrence rate. Complications were grouped into intraoperative and postoperative. The complication rate was 6.5%. Fifteen patients showed significant functional recovery. Conclusions: The posterior approach with lateral extension for the treatment of foramen magnum meningiomas and C1-C2 is safe, showing a low morbidity and mortality providing results comparable to other techniques. [ABSTRACT FROM AUTHOR]

Objective To study factors influencing oro-facial herpetic eruptions (HEs) in patients undergoing retromastoid suboccipital craniectomy for vestibular schwannomas (VS). Methods A retrospective analysis of the prospectively collected database (from July 2014 to December 2015). A total of 87 patients underwent retromastoid suboccipital craniectomy for VS at our center. For the purpose of analysis the patient subset was divided into 2 groups, HE and non-HE. Pearson χ 2 test or Fisher exact test were used to identify the factors. Results The overall incidence of postoperative HE was less than 1% (0.89%, 26 patients of 2916 cases); whereas after VS surgery, it was 20.69% (18 of 87). Demographic profiles of patients in the 2 groups were comparable. Average tumor size (with HE 3.19 ± 2 × 0.67 cm, non-HE 3.38 ± 2 × 1.07 cm), consistency, and laterality also were comparable between the 2 groups. Factors favoring development of postoperative HEs were large size (12 vs. 22, P = 0.013) and preoperative trigeminal nerve (CN V) involvement (9 of 18, 50%, P = 0.046). All patients developed HE in maxillary division of trigeminal nerve (V2), whereas involvement of ophthalmic (V1) and mandibular (V3) divisions were involved less commonly in combination with V2 (V2, 72.2%; V2 + V3, 22.2%; V1 + V2 + V3, 5.6%). The majority of the patients (55.56%) developed HE on postoperative day 3 and none beyond postoperative day 5. All patients responded to empirical oral acyclovir. Conclusions The study highlights the relatively high incidence and factors associated with this rare but benign complication. [ABSTRACT FROM AUTHOR]

In the last two decades, many studies have focused on the muscles and dense connective tissues located in the suboccipital region. Our study investigated the existence of the second terminations originating from the suboccipital muscles, and the relationship between the variable types of the To Be Named Ligament (TBNL). Anatomical dissection was performed on 35 head-neck specimens. The existence of the second terminations of the suboccipital muscles was confirmed and various types of the TBNL were observed in this study. The second terminations originated from multiple suboccipital muscles including the rectus capitis posterior minor (RCPmi), rectus capitis posterior major (RCPma) and obliquus capitis inferior (OCI) muscles, merged and terminated at the TBNL. The overall incidence of the second terminations of the suboccipital muscles was 34.29% and it varied among the various suboccipital muscle origins. 28.57% of the second terminations originated from the RCPma; 11.43% was from the RCPmi and 8.57% was from the OCI. Furthermore, there was a significant relationship between the existence of second terminations and the particular type of the TBNL. 95% of the arcuate type of the TBNL was accompanied with the second terminations which attached to their turning part, whereas only 10% of all the radiate type of the TBNL was accompanied with the second terminations. This study for the first time described the second terminations originating from multiple suboccipital muscles and demonstrated the relationship with the various types of the TBNL. We speculated that the second terminations maintain the arcuate TBNL and transfer tensile forces to the Myodural Bridge (MDB), thereby modulating the physiological functions of the MDB. [ABSTRACT FROM AUTHOR]

Purpose: Axial fractures in patients with a previous C2-pelvis posterior instrumented fusion are rare and may be challenging to manage. Motion preservation in the axial spine for these patients is important, as the C1-2 and Occipit-C1 joints are their only remaining mobile spinal segments. In this unique report, we present for the first time the use of a fusionless occipitocervical operation for the treatment of a type II odontoid fracture and unilateral C2 pars fracture adjacent to a previous C2-pelvis posterior instrumented fusion.Methods: Case report.Results: Three years after proximal extension of a T3-pelvis posterior instrumented fusion to C2, the patient sustained a displaced odontoid fracture and unilateral C2 pars fracture after a mechanical fall. She underwent fracture stabilization with extension of instrumentation to the occiput. No attempt at fusion was performed. Post-operatively, she was distraught by severely limited neck range of motion, which was reflected in worsening of health-related quality of life (HRQoL) scores. The fracture healed uneventfully after which the instrumentation from the occiput and C1 were removed, which resulted in improvement of neck range of motion. Two years post-operatively, HRQoL scores showed minimal neck disability (NDI 12), no neck or arm pain (VAS 0), and outstanding general health (EQ-5D 85 out of 100, SF-36 PCS 35.3, SF-36 MCS 41.1).Conclusion: In this one patient, instrumentation without fusion allowed for successful and timely union of a displaced odontoid fracture in a patient with a previous C2-pelvis fusion. Axial range of motion was preserved after instrumentation removal. [ABSTRACT FROM AUTHOR]

A lipoma is a slow-growing, benign tumor and is usually asymptomatic; hence, surgical intervention can often be avoided in patients with these tumors in the cervical and cranial area. Lipomas arise most commonly in the subcutaneous fat, but occasionally in muscle tissue. Intramuscular lipomas in the cervico-cranial area have rarely been reported. We describe here a patient with a large intramuscular lipoma in the deep cervical tissue. The patient experienced troublesome pain in the neck and occipital area, and surgical treatment was therefore suggested. Particularly in the cervical area, intramuscular lipomas sometimes invade the surrounding muscles and tissue layers and develop into an irregular mass, despite being benign. In addition, the cervical area has one of the most complex muscle structures. Nevertheless, surgical management of intramuscular lipoma in the cervical and cranial area is sometimes indicated, for example, in patients with clinical symptoms or masses with a tendency to grow large. [ABSTRACT FROM AUTHOR]