Search

Corpus callosum trauma has long been implicated in mild traumatic brain injury (mTBI), yet the mechanism by which forces penetrate this structure is unknown. We investigated the hypothesis that coronal and horizontal rotations produce motion of the falx cerebri that damages the corpus callosum. We analyzed previously published head kinematics of 115 sports impacts (2 diagnosed mTBI) measured with instrumented mouthguards and used finite element (FE) simulations to correlate falx displacement with corpus callosum deformation. Peak coronal accelerations were larger in impacts with mTBI (8592 rad/s2 avg.) than those without (1412 rad/s2 avg.). From FE simulations, coronal acceleration was strongly correlated with deep lateral motion of the falx center (r = 0.85), while horizontal acceleration was correlated with deep lateral motion of the falx periphery (r > 0.78). Larger lateral displacement at the falx center and periphery was correlated with higher tract-oriented strains in the corpus callosum body (r = 0.91) and genu/splenium (r > 0.72), respectively. The relationship between the corpus callosum and falx was unique: removing the falx from the FE model halved peak strains in the corpus callosum from 35% to 17%. Consistent with model results, we found indications of corpus callosum trauma in diffusion tensor imaging of the mTBI athletes. For a measured alteration of consciousness, depressed fractional anisotropy and increased mean diffusivity indicated possible damage to the mid-posterior corpus callosum. Our results suggest that the corpus callosum may be sensitive to coronal and horizontal rotations because they drive lateral motion of a relatively stiff membrane, the falx, in the direction of commissural fibers below.

Gorlin-Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder with high penetrance and variable expressivity. The classic triad originally described by Gorlin and Goltz in 1960 is composed of multiple nevoid basal cell carcinomas (NBCCs), odontogenic keratocysts (OKCs) in the jaws and bifid ribs. in 1977, this triad was modified by Rayner et al, and to GGS diagnosis, the OKCs had to appear in combination with calcification of the cerebellar falx or palmar and plantar pits. It may occur that although GGS syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed in an always complex clinical panel. The authors introduce an example in this report. In the present case, the patient had NBCCs, OKCs, and probably other signs of GGS since 1998, and has been treated for this conditions separated, without a diagnosis of a syndromic condition. A 54-year-old white woman was referred to the oral medicine service due to cyst located in the right mandibular body. She had history of skin cancer and undergone surgeries and radiotherapies for the lesions treatment, scars on the skin face due to the lesions removed, and a new ulcerated lesion on the back of was diagnosed. In addition, the patient presented frontal and parietal bossing leading to increased cranial circumference, hypertelorism, strabismus, broad base, and mandibular prognathism. To the image examination, skull radiography revealed calcification of the falx cerebri; on chest X-ray bifid rib was observed and spine radiography showed vertebral osteophytes. Panoramic radiograph showed a well-defined bilocular radiolucent image located in posterior and anterior mandibular region. The whole elements induced us to investigate the patient's past medical history, which revealed that since 1998 had the diagnosis of NBCC and OKC. A multidisciplinary approach becomes necessary for the diagnosis and follow-up of patients with GGS, considering the complexity of the clinical manifestations. Therefore, it is of primary importance for dental surgeons and dermatologists to know the signs and symptoms of GGS to perform early diagnosis and to avoid progression of the oral cysts or metastasis of the skin lesions.

Objective Intracranial chondroma is a rare and benign tumor with usual onset in young adulthood. The skull base is the most common site of occurrence although, less often, the tumors can appear at the falx cerebri or at the dural convexity. The differentiation of these lesions from meningiomas through imaging is generally difficult. Patient and methods Clinical case presentation and review of the current literature. Results / Case presentation We report a case of a 25-year-old male patient with a giant convexity chondroma with meningeal attachment in the right frontal lobe that was detected after a first generalized seizure. Based on the putative diagnosis of meningioma, the tumor was completely resected via an osteoplastic parasagittal craniotomy. The postoperative MRI confirmed the complete tumor resection. Histopathological analysis revealed the presence of a chondroma. Conclusion Intracranial chondromas are a rarity and their preoperative diagnosis based on neuroimaging is difficult. In young patients and those with skeletal disease, the differential diagnosis of a chondroma should be considered. In symptomatic patients, operative resection is sensible. In most cases total removal of the tumor is possible and leads to full recovery. When the finding is merely incidental in older patients, a watchful waiting approach is acceptable, given the benign and slow-growing nature of the lesion.

The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group on the membranous bone (DM group), and a falcotentorial group (FT group) in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragma sellae. The FT group was derived from the neural crest and designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized in the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The FT group was formed only with the dura propria that was considered as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs.

Background A large field of view (FOV) cone beam computed tomography (CBCT) scan can show an anatomic variant, such as pneumatization of the crista galli. The crista galli is a bony projection that extends superiorly from the cribriform plate of the ethmoid bone. It is located at the midline of the anterior cranial fossa and is where the falx cerebri attaches anteriorly. As there is no literature on this topic using CBCT imaging, we undertook this study to add to the research as well as to inform dentists and specialists about pneumatization of crista galli. Objective(s) The aim of this study was to report the prevalence of pneumatization of the crista galli using CBCT images and to compare the prevalence of pneumatization of crista galli in patients receiving nonsurgical versus surgical dental treatment. Study Design The study included 514 diagnostic CBCT scans from 2015 to 2016. Age, sex, treatment provided, and the size of pneumatized crista galli were recorded. The associations between age and sex versus pneumatization of the crista galli were evaluated using the Mann-Whitney U test. The associations between treatment and pneumatization of crista galli were assessed using Pearson's χ2 and Fischer's exact tests. Results The average age of the patients was 15.69 years. Pneumatization of crista galli occurred in 20 out of 514 (3.8%) patients. The median cranial–caudal length of a pneumatized crista galli was 4.78 mm in females and 5.62 mm in males. The median width was 4.49 mm in females and 6.98 mm in males. Patients with pneumatization were statistically significantly older than the patients without pneumatization (U = 3041.5; P = .004). Among the nonsurgical categories, orthodontic treatment was classified as significant (P = .008). Among surgical categories, orthognathic surgery was found to be significant in the presentation of pneumatization of the crista galli (P = .001). Fischer's exact test showed there was a significantly higher percentage of surgical patients with pneumatization compared with nonsurgical patients (P = .003). Discussion/Conclusions Age, orthodontic treatment, and orthognathic surgery were significantly associated with pneumatization of the crista galli. Gender did not contribute substantially to pneumatization of the crista galli.

Falx cerebri ossification is an incidental finding. Mostly it is easy to diagnose, but can be challenging in few cases, and should be distinguished from calcified meningioma, hematoma, and meningeal infiltration. We report a case of a 46-year-old woman with breast cancer complaining of back pain. F-NaF PET/CT images show focal increase uptake at facet joints of L5/S1 vertebrae and both knees joints, suggesting degenerative disease. There is normal variant F-NaF uptake noted in the ossification at the falx cerebri. Recognition of normal and abnormal extraosseous F-NaF uptake is important for correct interpretation to avoid unnecessary further investigations.

Safe access to intra-axial mesial cortical lesions is challenging. When approached through standard transcortical approaches, normal white matter tracts such as the superior longitudinal fasciculus, corona radiata, and optic radiations may be violated en route to the lesion. Conversely, use of ipsilateral interhemispheric approaches necessitates retraction and manipulation of edematous and friable perilesional tissue. The contralateral interhemispheric transfalcine (CIHTF) approach may circumvent these challenges. The CIHTF approach uses a gravity-created window between the ipsilateral hemisphere and the falx and allows direct access contralaterally by opening the falx. We demonstrate the CIHTF approach for an intra-axial, medial occipital/precuneus lesion in a 69-yr-old man presenting with left homonymous hemianopia. MRI revealed a heterogeneously enhancing intra-axial lesion in the right mesial occipital lobe. After the patient gave voluntary informed consent, a CIHTF approach was planned, with the patient positioned laterally, right side up (IRB approval was unnecessary). A lumber drain facilitated gravity autoretraction of the ipsilateral lobe. Within the created trajectory, the falx was opened with use of a nerve hook attached to monopolar electrocautery. The contralateral lesion was visualized and removed piecemeal with the assistance of fluorescence imaging. Postoperative MRI showed complete removal. The patient reported a significant vision improvement. The diagnosis was metastatic adenocarcinoma from the lung; subsequent radiosurgery was recommended. MRI at the 8-mo follow-up revealed no recurrence of the lesion. The CIHTF approach is feasible for a mesial intra-axial lesion because it offers gravity autoretraction, a large working angle, and avoidance of parenchymal swelling. Used with permission from Barrow Neurological Institute.

Absence of the falx cerebri is a rare radiological finding, which is generally described in relation with varying degrees of holoprosencephaly or other structural central nervous system anomalies. We present a case of non-syndromic, asymptomatic absence of falx cerebri in an elderly patient, which was discovered incidentally on a computed tomography examination of the head. The superior sagittal sinus was narrowed, but present. Relevant anatomic and embryological considerations are discussed, as well as potential implications for clinical practice. Keywords: Computed tomography, Incidental findings, Congenital abnormality, Brain, Falx cerebri

BACKGROUND AND IMPORTANCE Cavernous angiomas or cavernomas are vascular malformations usually located in the brain parenchyma. However, they rarely present as extra-axial lesions, attached to the dura, and may mimic meningiomas. Most reported cases concern the cavernous sinus region and other locations are very uncommon. CLINICAL PRESENTATION A 61-yr-old female known for long-standing mental illness presented with progressive gait instability. Imaging studies revealed an extra-axial lesion in relation to the anterior part of the falx cerebri. An interhemispheric approach was used to remove the lesion. Pathological analysis revealed features compatible with an extra-axial cavernoma: structureless vascular channels lacking smooth muscle and elastic lamellae, without intervening brain parenchyma. CONCLUSION Cavernous angiomas or cavernomas can present as extra-axial lesions. Although progressive growth can be observed, they should not be considered as tumoral lesions, because there is no cellular duplication. Unlike other locations, resection of anterior cranial fossa extra-axial cavernomas seems to be facilitated by minimal bleeding.

Purpose Magnetic resonance elastography (MRE) of the brain has demonstrated potential as a biomarker of neurodegenerative disease such as dementia but requires further evaluation. Cranial anatomical features such as the falx cerebri and tentorium cerebelli membranes may influence MRE measurements through wave reflection and interference and tissue heterogeneity at their boundaries. We sought to determine the influence of these effects via simulation. Methods MRE-associated mechanical stimulation of the brain was simulated using steady state harmonic finite element analysis. Simulations of geometrical models and anthropomorphic brain models derived from anatomical MRI data of healthy individuals were compared. Constitutive parameters were taken from MRE measurements for healthy brain. Viscoelastic moduli were reconstructed from the simulated displacement fields and compared with ground truth. Results Interference patterns from reflections and heterogeneity resulted in artifacts in the reconstructions of viscoelastic moduli. Artifacts typically occurred in the vicinity of boundaries between different tissues within the cranium, with a magnitude of 10%–20%. Conclusion Given that MRE studies for neurodegenerative disease have reported only marginal variations in brain elasticity between controls and patients (e.g., 7% for Alzheimer's disease), the predicted errors are a potential confound to the development of MRE as a biomarker of dementia and other neurodegenerative diseases. Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc.

Medial posterior frontal and parietal gliomas extending to the peri-atrial region are difficult to reach surgically because of the working angle required to expose the lateral aspect of the tumor and the proximity of the tumor to the sensorimotor lobule; retraction of the sensorimotor cortex may lead to morbidity. The interhemispheric transfalcine approach is favorable and safe for resection of medial hemispheric tumors adjacent to the falx cerebri, but the literature on this approach is scarce. Awake cortical mapping using this operative route for tumors associated with the sensorimotor cortex has not been previously reported to our knowledge. We present the first case of a right medial posterior frontoparietal oligoastrocytoma that was resected through the interhemispheric transfalcine approach using awake cortical and subcortical mapping. Through a contralateral frontoparietal craniotomy, we excised a section of the falx and exposed the contralateral medial hemisphere. Cortical stimulation allowed localization of the supplementary motor cortex, and suprathreshold stimulation mapping excluded the primary motor cortex corresponding to the leg area. Gross total tumor resection was accomplished without any intraoperative or postoperative deficits. Awake cortical mapping using the contralateral transfalcine approach allows a "cross-court" operative route to map functional cortices and resect peri-atrial low-grade gliomas. This technique can minimize the otherwise necessary retraction on the ipsilateral hemisphere through an ipsilateral craniotomy.

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare, autosomal dominant disorder characterized by multiple basal cell carcinomas (BCCs), odontogenic keratocysts, palmar and/or plantar pits, and ectopic calcifications of the falx cerebri. Myriad ophthalmologic findings are associated with NBCCS, including periocular BCCs, hypertelorism, strabismus, myelinated nerve fibers, and disorders of the retina and retinal pigment epithelium. We performed a literature search in PubMed for articles on the ophthalmologic manifestations of Gorlin syndrome, published between 1984 and 2014. Of 33 papers, 31 were included. Although Gorlin syndrome is due to mutations in a single gene, it displays variable phenotypic expressivity. Therefore, familiarity with this disorder across clinical specialties is necessary to avoid misdiagnosis. The ophthalmologist should be included in the multidisciplinary team for the management of Gorlin syndrome in order to prevent visual loss and improve the quality of life of these patients.

Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested.

Intracranial chondromas are benign, slow-growing, cartilaginous tumors, which comprise only about 0.2% of all intracranial tumors. The majority of these lesions occur at the base of the skull, where they are thought to arise from residual embryonic chondrogenic cells along the basal synchondrosis. Very rarely, they may also originate from the convexity dura, falx cerebri, or the brain parenchyma. We present a patient with a dural based chondroma to highlight the technical considerations of surgical resection. The recent literature on intracranial chondromas regarding incidence, pathophysiologic origin, clinical symptoms, imaging, histopathology and prognosis is reviewed.

The falx cerebri and tentorium cerebelli are dural structures found in the brain. Due to the roles both structures play in constraining brain motion, the falx and tentorium must be identified and included in finite element models of the head to accurately predict brain dynamics during injury events. To date there has been very little research work on automatically segmenting these two structures, which is understandable given that their 1) thin structure challenges the resolution limits of in vivo 3D imaging, and 2) contrast with respect to surrounding tissue is low in standard magnetic resonance imaging. An automatic segmentation algorithm to find the falx and tentorium which uses the results of a multi-atlas segmentation and cortical reconstruction algorithm is proposed. Gray matter labels are used to find the location of the falx and tentorium. The proposed algorithm is applied to five datasets with manual delineations. 3D visualizations of the final results are provided, and Hausdorff distance (HD) and mean surface distance (MSD) is calculated to quantify the accuracy of the proposed method. For the falx, the mean HD is 43.84 voxels and the mean MSD is 2.78 voxels, with the largest errors occurring at the frontal inferior falx boundary. For the tentorium, the mean HD is 14.50 voxels and mean MSD is 1.38 voxels.

The falx cerebri is a meningeal projection of dura in the brain, separating the cerebral hemispheres. It has stiffer mechanical properties than surrounding tissue and must be accurately segmented for building computational models of traumatic brain injury. In this work, we propose a method to segment the falx using T1-weighted magnetic resonance images (MRI) and susceptibility-weighted MRI (SWI). Multi-atlas whole brain segmentation is performed using the T1-weighted MRI and the gray matter cerebrum labels are extended into the longitudinal fissure using fast marching to find an initial estimate of the falx. To correct the falx boundaries, we register and then deform a set of SWI with manually delineated falx boundaries into the subject space. The continuous-STAPLE algorithm fuses sets of corresponding points to produce an estimate of the corrected falx boundary. Correspondence between points on the deformed falx boundaries is obtained using coherent point drift. We compare our method to manual ground truth, a multi-atlas approach without correction, and single-atlas approaches.

Background Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm; however, there is no available literature on use of the falx cerebri for wrap-clipping. We present a review of the literature, with an illustrative case, of a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention. Methods Although the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, and then stabilized with a fenestrated clip. We chose a segment slightly longer than the length of the fusiform aneurysm to avoid pre– and post–wrap-clipping stenosis. Results Postprocedure, except for a small area of numbness on the left distal anterolateral left leg, the patient was neurologically intact and remained neurologically intact at a 12-month follow-up. Conclusions An inferior thin segment of the falx cerebri can be used for wrap-clipping of ruptured fusiform anterior cerebral artery aneurysms. Furthermore, the inferior falx can be wrapped around the attached fusiform anterior cerebral artery aneurysm without compromising flow, offering a safe solution in these unusually complex cases.

Gorlin–Goltz syndrome (GGS) is a rare genetic syndrome with variable expressivity and autosomal dominant inheritance. The major features of GGS include numerous basal cell carcinomas (BCCs), keratocysts of the jaw, palmar/plantar pits and calcification of the falx cerebri. Authors report the case of a 51-year-old male with a 19-year history of GGS and multiple BCCs of the head and neck. He presented with a large ulcerating lesion on the right side of his face involving cutaneous, subcutaneous and muscular tissues of the temporal and orbital region. Additionally, magnetic resonance imaging revealed involvement of the right zygomatic bone, infratemporal fossa and mandible. This case is notable in that BCC invasion of the facial bones is rare. Extensive resection and reconstruction with a latissimus dorsi microvascular free muscle flap was performed. The success of this challenging case exemplifies the need for a multidisciplinary team that included dermatology, plastic surgery, oculoplastics and otolaryngology.

Sinusitis and otitis are common within the pediatric population. If left untreated, these can extend intracranially and lead to the development of infections in the various intracranial compartments resulting in a high rate of morbidity and mortality. We report the first case of an intrafalcine empyema, absent subdural purulence, in a patient with the likely spread from a sinogenic origin. This case illustrates the novelty of this as a pathological entity as well as the surgical considerations for intrafalcine purulence in the absence of expected subdural collections.

Background Complete or partial agenesis of the falx cerebri may occur in pediatric patients with developmental anomalies. However, isolated agenesis of the falx in a developmentally normal adult is exceptionally rare. We describe the first reported case of a patient with a third ventricular mass associated with partial agenesis of the anterior falx cerebri, a circumstance that influenced surgical access to a third ventricular epidermoid cyst. Case Description A 60-year-old developmentally normal woman presented with progressively worsening aphasia and altered mental status. Brain magnetic resonance imaging showed obstructive hydrocephalus from a third ventricular mass. An anterior interhemispheric transcallosal approach was planned to remove the tumor. However, upon dural opening there was no evidence of a falx cerebri, an anomaly visible but not reported on the prior imaging studies. An interhemispheric fissure was present, but the medial frontal lobes were densely adherent, with multiple traversing veins within the superficial arachnoid of the fissure. Therefore, a left frontal transcortical approach was performed for microsurgical resection of the tumor. Histopathologic analysis identified the lesion to be an epidermoid cyst. Conclusions Partial agenesis of the falx cerebri is exceedingly rare in a developmentally normal adult, particularly in the presence of an anatomically normal superior sagittal sinus. If present, however, it is important to note this association preoperatively because partial agenesis of the falx cerebri precludes an interhemispheric transcallosal approach to the lateral and third ventricles.

Intracranial chondromas are rare skull base tumors, but those arising from the falx cerebri are extremely rare. Of our knowledge, there have been reported no more than seventeen cases. Surgical gross removal of falx chondroma is associated with good outcome. We bring into focus the case of a large falcine chondroma and discuss its diagnosis, surgical management and prognosis.

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal genetic disease caused by a PTCH mutation. The disease is characterized by multiple basal cell carcinomas of the skin, multiple keratocystic odontogenic tumors (KCOTs) in the jaw, palmar and/or plantar pits, bifid ribs, ectopic calcification of the falx cerebri, and skeletal abnormalities. Early diagnosis is difficult in many cases because there may be a number of systemic symptoms. The purpose of this study is to report the case of a 12-year-old girl who was hospitalized with multiple KCOTs that occurred in the upper and lower jaws. Through characteristic clinical symptoms and radiologic findings, she was finally diagnosed as having NBCCS. This study also aims to organize the symptoms often observed in Korea using previously published case reports to provide useful information for the early diagnosis of NBCCS.

Basal cell nevus syndrome, also known as Gorlin–Goltz syndrome, shows five main pathological features: nevoid basal cell carcinomas; keratocystic odontogenic tumours; congenital skeletal anomalies; calcification of the falx cerebri; and point skin depressions on the palms and/or soles. We encountered a 62-year-old man with basal cell nevus syndrome appearing as multiple cystic lesions in the mandible and maxilla, along with bifid ribs. The multiple cystic lesions were identified on panoramic radiography and computed tomography. Bifid rib was apparent at the left eighth rib on postero-anterior radiography and computed tomography. The multiple cystic lesions were removed by an oral surgery team. Histopathological examination diagnosed the specimens as keratocystic odontogenic tumours. Findings were ambiguous regarding the diagnosis of basal cell nevus syndrome, so the patched homologue 1 ( PTCH1 ) gene was sequenced, identifying a novel mutation (1346T → A). These results strongly suggested that the phenotype had been caused by mutations in the PTCH1 gene. The patient was diagnosed with basal cell nevus syndrome based on genetic investigations. In addition, our findings suggest that a novel mutation (1346T → A) may cause osteoplasty of the mandible, maxilla and ribs.

The Pliocene fossil porpoise SDSNH 65276 has extremely elongate mandibular morphology, unlike that of any marine amniote, and is superficially most similar to the living bird species known as skimmers (Rynchops sp.). Endocasts of the pterygoid sinuses and endocranial cavity were digitally segmented from high-resolution X-ray CT scans of the specimen to explore internal anatomy of functionally and phylogenetically important anatomical features of this specimen and odontocetes in general. The sinuses are similar in volume and shape to extant porpoise species, but the dorsal extension of the preorbital lobes are particularly elongate as in the harbor porpoise (Phocoena phocoena). The cranial endocast also shows similarities with extant porpoises, but has much deeper interhemispheric fissures, which are filled by ossified meninges, particularly a deep falx cerebri and shallower tentorium cerebelli. Ossifications of these parts of the meninges may reflect faster angular accelerations of the head, deeper diving ability, or both. Penetrations of the endocranial cavity for cranial nerves and blood vessels are like those of extant porpoises. The internal skull morphology of this unique delphinoid sheds additional light both on its phylogenetic affinities and novel odontocete adaptations.

Background Angioleiomyomas (ALMs) are benign soft tissue tumors composed of various size vessels with abundant intervening smooth muscles. Intracranial ALMs are exceedingly rare with 12 reported cases to date presenting as extracerebral masses that mimic cerebral cavernous malformation or meningiomas. Objective We report a case of intracranial ALM of the falx cerebri imitating an atypical meningioma or hemangiopericytoma. Results and Conclusions Magnetic resonance imaging (MRI) features and perfusion-weighted MRI revealed special features that may be helpful to distinguish ALMs from meningiomas and should result in the consideration of rarer extracerebral tumors like ALMs.

Gorlin-Goltz syndrome or basal cell nevus syndrome is an autosomal dominant syndrome characterized by skeletal anomalies, numerous cysts observed in the jaw, and multiple basal cell carcinoma of the skin, which may be accompanied by falx cerebri calcification. Basal cell carcinoma is the most commonly skin tumor with slow clinical course and low metastatic potential. Its concomitance with Gorlin syndrome, resulting from a mutation in a tumor suppressor gene, may substantially change morbidity and mortality. A 66-year-old male patient with a history of recurrent basal cell carcinoma was presented with exophthalmus in the left eye and the lesions localized in the left lateral orbita and left zygomatic area. His physical examination revealed hearing loss, gapped teeth, highly arched palate, and frontal prominence. Left orbital mass, cystic masses at frontal and ethmoidal sinuses, and multiple pulmonary nodules were detected at CT scans. Basal cell carcinoma was diagnosed from biopsy of ethmoid sinus. Based on the clinical and typical radiological characteristics (falx cerebri calcification, bifid costa, and odontogenic cysts), the patient was diagnosed with metastatic skin basal cell carcinoma accompanied by Gorlin syndrome. Our case is a basal cell carcinoma with aggressive course accompanying a rarely seen syndrome.

Nevoid basal cell carcinoma, known as Gorlin Goltz Syndrome, is a rare hereditary condition, characterized by a wide range of developmental abnormalities and a predisposition to neoplasms. In this report, we discuss a case of a patient with Gorlin Goltz Syndrome, who was 16 years old when first admitted for an initial appointment. The patient was diagnosed, treated and followed up for 7 years to present day. This syndrome is associated with a broad spectrum of anomalies and neoplasms as basal cell carcinomas, odontogenic keratocysts, palmar and/or plantar pits, and ectopic calcifications of the falx cerebri. It affects multiple organ systems, which include skeletal, teeth, jaw, skin, eyes, reproductive organs, and neural system. All the features however, are rarely observed in a single patient. The following paper presents the significance of early diagnosis of Gorlin Goltz Syndrome and the importance of a multidisciplinary approach in providing proper treatment for the patient.

The Gorlin-Goltz syndrome is an infrequent multisystemic disease, which is inherited in an autosomal dominant manner. This shows a high level of penetrance and variable expressiveness, characterized by multiple basal cell nevi or carcinomas, odontogenic keratocysts, palmar and / or plantar pits, calcification of the falx cerebri, and is occasionally associated with internal malignancies. It is fundamental to know the major and minor criteria for the diagnosis and early preventive treatment of this syndrome. Here we report a case of a 30-year-old male with major and minor features of the Gorlin-Goltz syndrome, such as, strabismus, barrel-shaped chest, with drooping shoulders and mild kyphosis, polydactyly, hypertelorism, multiple basal cell carcinomas, calcification of the falx cerebri, C5-C7 bifida spine, and fusion of T1 and T2.

WOS: 000331859900006 PubMed ID: 24614393 Intracranial chondroma is a rare benign neoplasm that occurs most often at the skull base. In extremely rare instances, it arises from the dura mater of the convexity or from the falx cerebri. The tumor cells are thought to originate from meningeal fibroblasts, perivascular mesenchymal tissue, or ectopic chondrocytes. Because the clinical presentation of such cases is nonspecific and because neuroimaging findings are not pathognomonic, intracranial chondromas mimic other intracranial tumors. Herein, we report a chondroma originating from the dura mater in the frontal region. The patient had been followed-up radiologically for 3 years after a preliminary diagnosis of meningioma until the correct diagnosis of chondroma was established with postoperative histological examination.

Phase II monitoring with intracranial electroencephalography (ICEEG) occasionally requires bilateral placement of subdural (SD) strips, grids, and/or depth electrodes. While phase I monitoring often demonstrates a preponderance of unilateral findings, individual studies (video EEG, single photon emission computed tomography [SPECT], and positron emission tomography [PET]) can suggest or fail to exclude a contralateral epileptogenic onset zone. This study describes previously unreported techniques of trans-falcine and sub-frontal insertion of contralateral SD grids and depth electrodes for phase II monitoring in pediatric epilepsy surgery patients when concern about bilateral abnormalities has been elicited during phase I monitoring. Pediatric patients with medically refractory epilepsy undergoing stage I surgery for phase II monitoring involving sub-frontal and/or trans-falcine insertion of SD grids and/or depth electrodes at the senior author’s institution were retrospectively reviewed. Intra-operative technical details of sub-frontal and trans-falcine approaches were studied, while intra-operative complications or events were noted. Operative techniques included gentle subfrontal retraction and elevation of the olfactory tracts (while preserving the relationship between the olfactory bulb and cribriform plate) to insert SD grids across the midline for coverage of the contralateral orbito-frontal regions. Trans-falcine approaches involved accessing the inter-hemispheric space, bipolar cauterization of the anterior falx cerebri below the superior sagittal sinus, and sharp dissection using a blunt elevator and small blade scalpel. The falcine window allowed contralateral SD strip, grid, and depth electrodes to be inserted for coverage of the contralateral frontal regions. The study cohort included seven patients undergoing sub-frontal and/or trans-falcine insertion of contralateral SD strip, grid, and/or depth electrodes from February 2012 through June 2015. Five patients (71%) experienced no intra-operative events related to contralateral ICEEG electrode insertion. Intra-operative events of frontal territory venous engorgement (1/7, 14%) due to sacrifice of anterior bridging veins draining into the SSS and avulsion of a contralateral bridging vein (1/7, 14%), probably due to prior anterior corpus callosotomy, each occurred in one patient. There were no intra-operative or peri-operative complications in any of the patients studied. Two patients required additional surgery for supplemental SD strip and/or depth electrodes via burr hole craniectomy to enhance phase II monitoring. All patients proceeded to stage II surgery for resection of ipsilateral epileptogenic onset zones without adverse events. Trans-falcine and sub-frontal insertion of contralateral SD strip, grid, and depth electrodes are previously unreported techniques for achieving bilateral frontal coverage in phase II monitoring in pediatric epilepsy surgery. This technique obviates the need for contralateral craniotomy and parenchymal exposure with limited, remediable risks. Larger case series using the method described herein are now necessary.

This patient presented with a cavernous malformation in the inferior posterior third ventricle extending into the aqueduct. The patient was positioned supine on the operating room table with the head rotated into the horizontal plane. The choroidal fissure is opened lateral to the choroid plexus. This technique allows for the choroid plexus to serve as protection against forniceal manipulation. Rigid retraction was applied to the cerebral falx and corpus callosum to permit aqueductal visualization. The lighted instruments are paramount for adequate visualization of the third ventricle and during dissection of the lesion. Intraoperative visualization and postoperative imaging confirm gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute.

Hypertrophic pachymeningitis is a rare inflammatory disease of the dura matter characterised by localized or diffuse thickening of the dura mater with fibrosis. Hypertrophic pachymeningitis is often secondary to infections, carcinomatosis or inflammatory diseases. It may also be idiopathic. We report a case of pachymeningitis which was A 45-year-old female presented with left-extremity focal seizure. MRI revealed diffuse pachymeningeal thickening showing intense post contrast enhancement involving falx cerebri and along bilateral fronto-parietal convexities. These findings suggest either Neurosarcoidosis, Behcet’s disease, SLE,Idiopathic hypertrophic pachymeningitis or IgG4 related hypertrophic pachymeningitis.

Gorlin–Goltz syndrome (GGS) also known as the nevoid basal cell carcinoma syndrome or the nevus–Bifid rib syndrome is an inherited autosomal dominant syndrome. It is caused by genetic alteration produced by a mutation in the “patched” tumor suppressor gene. This rare syndrome is characterized by basal cell carcinoma of skin, multiple odontogenic keratocyst and bifid ribs along with other features such as hypertelorism, sex organ abnormalities, palmar and/or plantar pits and calcification of falx cerebri. Early detection and treatment are essential for patients suffering from this syndrome. Only a few cases of this syndrome with familial background have been reported from India. In this study, we present a rare case of GGS in a mother and her daughter. The purpose of this study is to discuss the role of a dentist in early detection and the need for a multidisciplinary approach for the treatment of this syndrome.

Neurocysticercosis is common in children but calcification of falx cerebri is extremely rare. We report a 5-year-old male child with falcine calcification, who was diagnosed as neurocysticercosis based on clinical, epidemiological, serological and imaging findings. The child was treated with albendazole and carbamazepine and seizure free for last 2 years.

Basal cell nevus (Gorlin-Goltz) syndrome is a rare autosomal dominant disorder with multiple developmental anomalies and predisposition to various neoplasms. We present a 60 year old male with pigmented, ulcerated skin lesions in face, neck and trunk, histologically proved to be basal cell carcinomas. Mild exopthalmos, hypertelorism, chest wall deformity & scoliosis were noted. Radiological imaging showed calcification of falx cerebri & tentorium cerebelli, bridging of sella turcica, right third, fourth and fifth bifid ribs, scoliosis of lumbar spine, odontogenic keratocyst of mandible and flame shaped lucencies in hands. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 94-98 DOI: http://dx.doi.org/10.3126/njr.v3i1.8821

Gorlin–Goltz syndrome is an infrequent multisystemic disease that is inherited in an autosomal dominant way showing a high level of penetrance & variable expressiveness. It is about a multisystemic process that is characterized by the presence of odontogenic keratocysts in the jaws, multiple basal cell nevi or carcinomas, palmar and/or plantar pits & calcification of falx cerebri. Diagnosis of Gorlin–Goltz syndrome is made by having two major criteria or one major & two minor criteria. Here, we report a case of a 11-year-old girl suffering from this syndrome presenting with two new entities namely bifid tongue & partial ankyloglossia.

Background and importance Anatomic variations of the superior sagittal sinus (SSS) and falx cerebri (FC) are uncommon in that agenesis of these structures is extremely rare. We report an extremely rare anatomic variation, total agenesis of the SSS and FC, and briefly discuss it from the anatomical, embryological, radiological, and clinical perspectives. Clinical presentation A 49-year-old woman presented with long-standing headache, gait disturbance, and nausea. Imaging studies showed a bilateral subdural hematoma crossing the midline, dilated venous structures, and perineural cysts, but SSS and FC. Following right-sided hemiparesis and consciousness disturbances, the subdural hematoma was evacuated from a left-sided parietal burr hole because of thick hematoma in this side. After the surgical evacuation, the hemiparesis and consciousness disturbances were regressed; however, she still had severe headache. On account of ongoing headaches and related imaging findings, it was thought that she had possible spontaneous intracranial hypotension. She was treated with autologous epidural blood patch and recovered well. Conclusion Agenesis of the SSS and FC are extremely rare variations. Agenesis of the SSS results in development of alternative venous pathways and may lead to misdiagnosis as dural arteriovenous fistulas. Agenesis of FC may cause diagnostic confusion, because subdural pathologies such as hematomas can cross the midline in rare occasions.

Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome is inherited in an autosomal dominant way, although sporadic cases have been reported. This syndrome shows a high penetrance and variable expressivity and is a multisystemic process characterized by the presence of multiple pigmented basocellular carcinomas, keratocysts in the jaws, palmar and plantar pits and calcification of the falx cerebri. Together with these major features a great number of processes considered as minor features have also been described, such as numerous skeletal, dermatology related and neurological anomalies. Due to the importance of oral maxillofacial manifestations of this syndrome it is fundamental to know its characteristics in order to make a diagnosis and initiate an early preventive treatment. This paper reports the case of a 20-year-old male patient with Gorlin-Goltz syndrome, emphasizing the clinical and radiographic manifestations. This case report highlights the importance of dental health professionals in the early diagnosis of Gorlin-Goltz syndrome and in a preventive multidisciplinary approach to provide a better prognosis for the patient.

Magnetic resonance (MR) imaging characteristics of intracranial granular cell tumors (GCTs) have been previously reported in three dogs. The goal of this retrospective study was to examine a larger number of dogs and determine whether distinctive MR characteristics of intracranial GCTs could be identified. Six dogs with histologically confirmed intracranial GCTs and MR imaging were included. Tumor location, size, mass effect, T1- and T2-weighted signal intensity, and peritumoral edema MR characteristics were recorded. In all dogs, GCTs appeared as well-defined, extra-axial masses with a plaque-form, sessile distribution involving the meninges. All tumors were located along the convexity of the cerebrum, the falx cerebri, or the ventral floor of the cranial vault. All tumors were mildly hyperintense on T1-weighted images, and iso- to hyperintense on T2-weighted images. A moderate-to-severe degree of peritumoral edema and mass effect were evident in all dogs. Findings indicated that, while several MR imaging characteristics were consistently identified in canine cerebral GCTs, none of these characteristics were unique or distinctive for this tumor type alone.

Background Although many neurological complications have been described in acute Epstein–Barr virus infection, few reports have discussed the central nervous system complications in chronic active Epstein–Barr virus (CAEBV) infection. Methods We retrospectively surveyed the medical records of 14 patients with CAEBV infection in our institute. Neuroradiological studies were performed in 10 of these patients. Results Five had no neurological symptoms, whereas two presented with posterior reversible encephalopathy syndrome, one presented with basal ganglia calcification, and one presented with falx cerebri hemorrhage. Although both of the posterior reversible encephalopathy syndrome cases developed epilepsy several years after recovering from prolonged neurological deterioration, the others had no neurological sequelae. Conclusions This study revealed that various central nervous system complications may occur during the clinical course in pediatric CAEBV patients.

Gorlin-Goltz syndrome is a rare autosomal dominant disorder that involves multiple organ systems, including the skin, skeleton and jaws. We report a case of young female with multiple odontogenic keratocysts, high arched palate, euryopia, palmer pits, solitary, pigmented nevus , areas of hyper-pigmentation in the upper eyelid of left eye, dorsal surface of hands, calcified diaphragma sellae, right 5 th bifid rib & extensive bilamellar calcifications of the falx cerebri. Based on the combination of imaging and clinical findings the diagnosis of Gorlin-Goltz syndrome was made. Keywords - bifid rib, calcification, Gorlin-Goltz syndrome, OKC, palmer pits. I. Introduction Gorlin-Goltz syndrome or Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare hereditary disorder. It is also called as the fifth phakomatosis due to the presence of multiple cutaneous, skeletal, ophthalmic and neurological abnormalities. Patients have multiple manifestations that include basal cell carcinoma, odontogenic cysts, skeletal anomalies, prognathism, calcification of tentorium and falx. These patients are predisposed to various anomalies and neoplasms. (1,2) We are discussing here the possibility that the current case is an expression of NBCCS and are briefly reviewing the features of the Gorlin-Goltz syndrome. Our case highlights the importance of the awareness of this rare syndrome especially in young people without any skin lesions. We have seen that it is useful to keep in mind the existence of the syndrome and recognize the presence of some major criteria (odontogenic cysts of the jaw or calcifications of falx cerebri and tentorium) as these are easily recognizable in CT scan of the head and neck thus establishing the diagnosis, and increasing the chances for better overall survival rates. II. CASE REPORT A young patient came to our Department of Oral Medicine & Radiology with a complaint of slowly growing bilateral facial swelling since one year. She gave history of a large sized, unilateral facial swelling of the left side 12 years back and subsequent surgical treatment of the left mandibular tumor under general anesthesia. Excision of the tumor with drainage of pus had done on the left side of mandible. Since last one year, the swellings on both sides had spontaneously developed. The swelling on right side had grown very slowly over a period of last one year and attained the present size while the swelling on left side was observed since 3 months. Patient gave history of dull pain which was localized to the sites of swelling, which preceded and lasted for 10-15 days after which there had been no such episode. Since then, patient gave history of restricted mouth opening associated with onset of swelling. Patient also gave history of intermittent intra-oral yellowish, red discharge from the left side mucosa, leaving behind a metallic taste for 5-7 days. Patient neither gave history of swelling appearing elsewhere in the body nor other changes such as ulcerations, inflammation, paraesthesia. There was no evidence of loss of body weight associated with the appearance of swelling. She gave history of irregular & painful menstrual cycles. Otherwise there was no relevant medical history. Patient was not addicted to any deleterious habits. There was no relevant family history of similar and other types of illnesses.