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Background: The pituitary gland also known as the "master gland," is involved in maintaining the homeostasis of various body functions. The pituitary gland is comprised of adenohypophysis and neurohypophysis, and stays in an indent in the sphenoid bone called sella turcica. Objective: To determine the diagnostic accuracy of dynamic contrast Magnetic Resonance Imaging (MRI) in symptomatic patients with pituitary macroadenoma keeping histopathology as gold standard. Methods: Cross-sectional study carried out in Department of Radiology, Tertiary Care Hospital, Lahore from May 2019 to Oct 2020. Prospective. One hundred and one patients (101) were enrolled. Dynamic contrast magnetic resonance imaging (MRI) of patients was performed on 1.5 Tesla GE MRI machine using head coil. Transsphenoidal endoscopic surgery of seventy-five patients was done due to their progressing symptoms and out of these four patients lost to follow up. All the available post operative specimens were reviewed by experienced histopathologist and were labelled as positive and negative for pituitary macroadenoma. Results: Mean age of patients (n=71) was 37.4 years. Out of 71 patients, MRI showed pituitary macroadenoma in 64 patients (90.1%) of which two were false positives. 3 patients (4.2%) showed pituitary microadenoma, 1 (1.4%) represented meningioma, 1 (1.4%) showed craniopharyngioma and 2 (2.8%) showed pituitary hyperplasia. Sensitivity was found to be 96.9%, specificity was 71.4%, positive predictive value (PPV) was 96.9%, negative predictive value (NPV) was 71.4% and accuracy of dynamic contrast MRI in detecting pituitary macroadenoma was 94.3%. Conclusion: Dynamic contrast MRI is an authentic and non-invasive diagnostic imaging modality due to its better soft tissue contrast, multiplanar images and no risk of ionizing irradiation that allows the detection of pituitary macroadenoma with high sensitivity, specificity and accuracy. It also provides practical information about the interrelation of the gland with adjoining anatomical structures and helps to schedule medical or surgical treatment. [ABSTRACT FROM AUTHOR]

Changes in sella turcica (ST) development may be associated with impaction of the permanent canine teeth. Calcification of the interclinoid ligament, which forms a bridge between the anterior and posterior clinoid processes of the sphenoid bone, has been termed ST bridging. The aim of this study was to evaluate whether an association exists between ST bridging and the presence of impacted maxillary canines (IMCs) in a Brazilian population. In this case-control study, 2 blinded and calibrated examiners measured the length (interclinoidal distance), depth, and diameter of the ST on cephalometric radiographs of 64 adults divided into a case group with IMCs (n = 32) and a control group without IMCs (n = 32). The degree of calcification was established as no (class I), partial (class II), or complete (class III) calcification. A t test was used to compare ST dimensions between the groups, and a chi-square test was used to analyze the association between the degree of calcification and the groups. The association between ST bridging and IMC was estimated by means of logistic regression analysis (α = 0.05). The study findings showed that ST length in the case group was shorter than that in the control group (P = 0.042; t test), and the length was shorter in men than in women (P = 0.038; t test). The ST bridging frequency was higher in the case group (P = 0.03; chi-square test), and there was no difference between men and women. The presence of ST bridging might be associated with increased odds of IMCs (P < 0.01; adjusted odds ratio = 5.92). In this patient sample, the occurrence of IMCs was positively associated with the presence and severity of ST bridging. [ABSTRACT FROM AUTHOR]

Introduction: Sella turcica is an intracranial bone depression located in the sphenoid bone that houses the pituitary gland, which is an important gland in the secretion of various hormones. Literature review: Variations in the morphology of the sella turcica can alter the morphology of the pituitary, which can lead to changes in hormone secretion and dental anomalies. There are studies that evaluate the sella turcica using metric methods and other studies that evaluate them with non-metric methods. Researchers use lateral radiographs and/or computed tomography to visualize the sella turcica. The purpose of this brief review was to revise the methods used to study sella turcica morphology in dental research. The literature search for sella turcica morphology was carried out with the following key words (sella turcica, bridging of sella, size, shape of sella turcica and sella turcica morphology) and using the search engines (Pubmed and Google scholar). According to the research, three methods of analyzing the sella turcica were observed, according to the measurements (length, width, diameter, area, depht, sella height posterior, sella height anterior), degree of calcification (class I / type I / group I, class II / type II / group II, class III / type III / group III) and format (normal sella turcica, sella turcica bridge type A – ribbon-like fusion, sella turcica bridge type B – extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part of the sella turcica, pyramidal shape of the dorsum sella, double contour of the floor, oblique anterior wall, oblique contour of the floor) of the sella turcica. Conclusion: It is expected that the three methods exposed in this review will help dental researchers to analyze sella turcica. to the measurements (length, width, diameter, area, depht, sella height posterior, sella height anterior), degree of calcification (class I / type I / group I, class II / type II / group II, class III / type III / group III) and format (normal sella turcica, sella turcica bridge type A – ribbon-like fusion, sella turcica bridge type B – extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part of the sella turcica, pyramidal shape of the dorsum sella, double contour of the floor, oblique anterior wall, oblique contour of the floor) of the sella turcica. Conclusion: It is expected that the three methods exposed in this review will help dental researchers to analyze sella turcica. [ABSTRACT FROM AUTHOR]

Malignant ischemic infarction in the territory supplied by the middle cerebral artery is an extremely severe form of ischemic stroke associated with development of massive uncontrollable postischemic edema of the affected cerebral hemisphere; the end result of which is development of transtentorial herniation and death. Method: The surgical technique of performance of decompressive hemicraniectomy involves removal of an extensive bone flap in the fronto-temporo-parieto-occipital zone with resection of the temporal squama and of the greater wing of the sphenoid bone to visualize the level of entrance of the middle meningeal artery to the cranial cavity, which, in its turn, allows resection of the upright margin of the middle cranial fossa. Decompressive hemicraniectomy is supplemented with resection of the temporal pole and tentoriotomy. Conclusion: Performance of decompressive hemicraniectomy in combination with resection of the resection of the temporal pole and tentoriotomy is an effective surgical method of treatment of malignant ischemic stroke in the territory supplied by the middle cerebral artery, capable of reducing the lethality rate during the postoperative period. [ABSTRACT FROM AUTHOR]

The vasculature of the pituitary gland is discussed briefly and the details of an anatomical discovery of the vessels supplying the pituitary gland provided. Twenty latex injected cadaveric heads were dissected. Any vessels that were found to penetrate the sella turcica and travel to the pituitary gland were documented and measured. Additionally, 25 adult skulls were evaluated for the presence, size, and sites of bony foramina in the floor of sella turcica. Trans-sellar vessels were identified in 65% of specimens. There was a mean of 1.5 vessels per specimen consisting usually of a mixture of veins and arteries. The mean diameter of these vessels was 0.3 mm and the mean length from the sella turcica to the pituitary gland was 2.3 mm. These vessels were concentrated in the most concave part of the sella turcica. In bony specimens, the mean number of transsellar foramina was four. The diameter of these foramina ranged from 0.3 to 0.6 mm in size. The trans-sellar foramina were concentrated near the center part of the sella turcica and had no regular pattern. The pituitary gland receives at least some blood supply and drainage via vessels traveling along the septum of the sphenoidal sinuses and through the sella turcica. Knowledge of such vessels might lead to a better understanding of the vascular supply and drainage of the pituitary gland and would be useful during skull base approaches such as trans-nasal approaches to the pituitary gland. [ABSTRACT FROM AUTHOR]

Although adequate venous drainage from the cranium is imperative for maintaining normal intracranial pressure, the bony anatomy surrounding the inferior petrosal sinus and the potential for a compressive canal or tunnel has, to our knowledge, not been previously investigated. One hundred adult human skulls (200 sides) were observed and documented for the presence or absence of an inferior petrosal groove or canal. Measurements were made and a classification developed to help better understand their anatomy and discuss it in future reports. We identified an inferior petrosal sinus groove (IPSG) in the majority of specimens. The IPSG began anteriorly where the apex of the petrous part of the temporal bone articulated with the sphenoid part of the clivus, traveled posteriorly, in a slight medial to lateral course, primarily just medial to the petro-occipital fissure, and ended at the anteromedial aspect of the jugular foramen. When the IPSGs were grouped into five types. In type I specimens, no IPSG was identified (10.0%), in type II specimens, a partial IPSG was identified (6.5%), in type III specimens, a complete IPSG (80.0%) was identified, in type IV specimens, a partial IPS tunnel was identified (2.5%), and in type V specimens, a complete tunnel (1.0%) was identified. An improved knowledge of the bony pathways that the intracranial dural venous sinuses take as they exit the cranium is clinically useful. Radiological interpretation of such bony landmarks might improve patient diagnoses and surgically, such anatomy could decrease patient morbidity during approaches to the posterior cranial fossa. [ABSTRACT FROM AUTHOR]

Sonicating deep brain regions with pulsed focused ultrasound using magnetic resonance imaging-guided neuronavigation single-element piezoelectric transducers is a new area of exploration for neuromodulation. Upper cranial nerves such as the trigeminal nerve and other nerves responsible for sensory/motor functions in the head may be potential targets for ultrasound pain therapy. The location of upper cranial nerves close to the skull base poses additional challenges when compared with conventional cortical or middle brain targets. In the work described here, a series of computational and empirical testing methods using human skull specimens were conducted to assess the feasibility of sonicating the trigeminal pathway near the sphenoid bone region. The results indicate a transducer with a focal length of 120 mm and diameter of 85 mm (350 kHz) can deliver sonication to upper cranial nerve regions with spatial accuracy comparable to that of focused ultrasound brain targets used in previous human studies. Temperature measurements in cortical bone and in the skull base with embedded thermocouples yield evidence of minimal bone heating. Conventional pulse parameters were found to cause reverberation interference patterns near the cranial floor; therefore, changes in pulse cycles and pulse repetition frequency were examined for reducing standing waves. Limitations and considerations for conducting ultradeep focal targeting in human applications are discussed. [ABSTRACT FROM AUTHOR]

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The sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand. This study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05. The study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038). Our results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion. [ABSTRACT FROM AUTHOR]

The foramen ovale (FO) is a crucial feature of the skull base, serving as a passage for clinically important neurovascular structures. The present study aimed to provide a comprehensive morphometric and morphologic analysis of the FO and highlight the clinical significance of the anatomical characterization. A total of 267 FO were analyzed in skulls obtained from deceased inhabitants of the Slovenian territory. The anteroposterior (length) and the transverse (width) diameters were measured using a digital sliding vernier caliper. Dimensions, shape, and anatomical variations of FO were analyzed. The mean length and width of the FO were 7.13 and 3.71 mm on the right side and 7.20 and 3.88 mm on the left side. The most frequently observed shape was oval (37.1%), followed by almond (28.1%), irregular (21.0%), D-shaped (4.5%), round (3.0%), pear-shaped (1.9%), kidney-shaped (1.5%), elongated (1.5%), triangular (0.7%), and slit-like (0.7%). In addition, marginal outgrowths (16.6%) and several anatomical variations were noted, including duplications, confluences, and obstruction due to a complete (5.6%) or incomplete (8.2%) pterygospinous bar. Our observations revealed substantial interindividual variation in the anatomical characteristics of the FO in the studied population, which could potentially impact the feasibility and safety of neurosurgical diagnostic and therapeutic procedures.

To date, tumors, the second cause of death worldwide, are a modern medicine plight. The development of rapid, cost-effective and reliable prevention and diagnostics tools is mandatory to support clinicians and ensure patients' adequate intervention. Pituitary tumors are a class of neoplasm, which calls for suitable and ad hoc diagnostic tools. Recently, microwaves have gained interest as a non-ionizing, non-invasive valuable diagnostic approach for identifying pathologic tissues according to their dielectric properties. This work deals with the preliminary investigation of the feasibility of using microwaves to diagnose pituitary tumors. In particular, it focuses on benign tumors of the adenohypophysis, e.g., the pituitary adenomas. It is assumed to access the region of interest of the pituitary region by following a trans-sphenoidal approach. The problem was modeled by developing an equivalent transmission line model of the multi-layered, lossy tissues (front bone of sphenoid sinuses, air in the sinuses, posterior bone of sphenoid sinuses, the pituitary gland and the tumor). The forward problem was developed to investigate the transmission coefficient for identifying the most favorable propagation conditions. Then, it was analyzed if, by the solution of an inverse problem, it is possible to reconstruct the permittivity and electrical conductivity profiles and identify the tumor presence. The results are promising since a maximum reconstruction error of 8% is found, in the worst case, thus paving the way for the use of microwaves for the diagnosis of pituitary tumors. [ABSTRACT FROM AUTHOR]

Objective : The aim of this study was to evaluate the clinical outcome of sphenoid wing meningioma with periorbital invasion (PI) after operation. Methods : Sixty one patients with sphenoid wing meningioma were enrolled in this study. Their clinical conditions were monitored after the operation and followed up more than 5 years at the outpatient clinic of a single institution. Clinical and radiologic information of the patients were all recorded including the following parameters : presence of PI, presence of peri-tumor structure invasion, pathologic grade, extents of resection, presence of hyperostosis, exophthalmos index (EI), and surgical complications. We compared the above clinical parameters of the patients with sphenoid wing meningioma in the presence or absence of PI (non-PI), then linked the analyzed data with the clinical outcome of the patients. Results : Of 61 cases, there were 14 PI and 47 non-PI patients. PI group showed a significantly higher score of EI (1.37±0.24 vs. 1.00±0.01, p<0.001), more frequent presence of hyperostosis (85.7% vs. 14.3%, p<0.001), and lower rate of gross total resection (GTR) (35.7% vs. 68.1%, p=0.032). The lower score of pre-operative EI, the absence of both PI and hyperostosis, smaller tumor size, and the performance of GTR were associated with lower recurrence rates in the univariate analysis. However, in the multivariate analysis, the performance of GTR was the only significant factor to determine the recurrence rate (p=0.043). The incidences of surgical complications were not statistically different between the subtotal resection (STR) and GTR groups, but it was strongly associated tumor size (p=0.017). Conclusion : The GTR group showed lower recurrence rate than the STR group without differences in the surgical complications. Therefore, the GTR is strongly recommended to treat sphenoid wing meningioma with PI for the better clinical outcome. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of surgery for skull base meningiomas is maximal resection with minimal damage to the involved cranial nerves and cerebral vessels. Compared to non-skull base meningiomas, these lesions show a reduced rate of gross total resection (GTR). Therefore, the use of technologies for improved orientation in the surgical field, such as neuronavigation and augmented reality (AR), is of interest. We confirmed in a consecutive series of 39 patients who underwent surgery for skull base meningiomas that automatic registration with intraoperative computed tomography (iCT) showed high registration accuracy and that microscope-based AR largely facilitated the resection by increasing surgical precision and providing improved intraoperative orientation by visualizing the tumor and the critical neurovascular structures in the operative microscope. No injuries to critical neurovascular structures occurred. There were 26 patients (66.6%) who underwent GTR. Additionally, 33 out of 35 patients who lived to follow-up could ambulate. Background: The aim of surgery for skull base meningiomas is maximal resection with minimal damage to the involved cranial nerves and cerebral vessels; thus, implementation of technologies for improved orientation in the surgical field, such as neuronavigation and augmented reality (AR), is of interest. Methods: Included in the study were 39 consecutive patients (13 male, 26 female, mean age 64.08 ± 13.5 years) who underwent surgery for skull base meningiomas using microscope-based AR and automatic patient registration using intraoperative computed tomography (iCT). Results: Most common were olfactory meningiomas (6), cavernous sinus (6) and clinoidal (6) meningiomas, meningiomas of the medial (5) and lateral (5) sphenoid wing and meningiomas of the sphenoidal plane (5), followed by suprasellar (4), falcine (1) and middle fossa (1) meningiomas. There were 26 patients (66.6%) who underwent gross total resection (GTR) of the meningioma. Automatic registration applying iCT resulted in high accuracy (target registration error, 0.82 ± 0.37 mm). The effective radiation dose of the registration iCT scans was 0.58 ± 1.05 mSv. AR facilitated orientation in the resection of skull base meningiomas with encasement of cerebral vessels and compression of the optic chiasm, as well as in reoperations, increasing surgeon comfort. No injuries to critical neurovascular structures occurred. Out of 35 patients who lived to follow-up, 33 could ambulate at their last presentation. Conclusion: A microscope-based AR facilitates surgical orientation for resection of skull base meningiomas. Registration accuracy is very high using automatic registration with intraoperative imaging. [ABSTRACT FROM AUTHOR]

Simple Summary: Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. They present a challenge to neurosurgeons, especially when they invade critical neurovascular structures and the cavernous sinus. This study was designed to evaluate prognostic features influencing recurrence and progression-free survival of medial sphenoid meningiomas invading the cavernous sinus, with a particular focus on the impact of surgery and postoperative radiotherapy. A retrospective analysis was conducted of the database of our institution. Included were 105 cases of medial sphenoid wing meningiomas with invasion of the cavernous sinus, of which 64 were treated by surgery alone and 41 were treated by surgery plus radiotherapy. Near-total resection did reduce the risk of tumor recurrence significantly compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy. In conclusion, we found that performing a maximal safe resection is the factor most strongly associated with a lower recurrence rate in patients with medial sphenoid meningioma infiltrating the cavernous sinus, and that postoperative stereotactic radiotherapy of the residual tumor also significantly prolongs PFS. Objective: Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy. Methods: A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan–Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality. Results: The risk of recurrence was significantly reduced after near-total resection (NTR) (p-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (p-value = 0.0002). Conclusions: Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus. [ABSTRACT FROM AUTHOR]

Objectives: We estimated volume changes in the posterior bony wall of the sphenoid sinus, as well as alterations in nasal function (including olfactory function and subjective symptoms), after sphenoid mucosal repositioning using the endoscopic endonasal transsphenoidal approach (EETSA). Methods: During 2010 and 2021, 13 patients underwent sphenoid mucosal repositioning during EETSA, while 24 patients (the control group) did not. Pre‐ and postoperative paranasal sinus computed tomography and the Mimics program were used to evaluate three‐dimensional changes in the posterior wall of the sphenoid sinus. All patients underwent the Connecticut Chemosensory Clinical Research Center (CCCRC) test, the Cross‐Cultural Smell Identification Test (CCSIT), Nasal Obstruction Symptoms Evaluation (NOSE), the Sino‐Nasal Outcome Test‐20 (SNOT‐20), and visual analog scale (VAS) evaluation. Results: The increase in the volume of the posterior wall of the sphenoid sinus after surgery was objectively smaller in the sphenoid mucosal repositioning group than in the control group (P =.046). However, this did not affect olfactory function (as revealed by the CCCRC test or the CCSIT) or subjective symptoms (as revealed by the NOSE, SNOT‐20, and VAS scores) (all P >.05). Conclusion: Surgical closure via sphenoid mucosal repositioning during EETSA reduces the volume of the posterior wall of the sphenoid sinus and facilitates re‐operation. We suggest that sphenoid mucosal repositioning is appropriate during EETSA. Level of Evidence: 4 Laryngoscope, 132:965–972, 2022 [ABSTRACT FROM AUTHOR]

Background: Considering the late ossification potential of spheno-occipital synchondrosis (SOS), it can be used as a tool to estimate age in adolescents. The time of SOS fusion is known to vary in different populations. Objectives: This study aimed to assess the degree of SOS fusion in Iranian individuals, using cone-beam computed tomography (CBCT) scan. Patients and Methods: The CBCT images of 240 patients (126 females and 114 males), aged 6 - 25 years, were assessed regarding the degree of SOS fusion, based on a four-stage scoring system. Spearman's correlation coefficient test and regression analysis were performed to assess the correlation between age and fusion stage. Mann-Whitney test was also applied to determine differences between males and females. Besides, Kruskal-Wallis test was used to assess differences in the median values. Results: The SOS was completely open at the mean age of 7.63 years in females and 8.85 years in males. The mean age of partially fused SOS (stage 1) was 8 years in females and 10 years in males. Besides, the mean age of completely fused SOS (stage 3) was 12 years in females and 16 years in males. The results of Spearman's correlation coefficient test showed a significant positive relationship between age and the degree of SOS fusion in males and females (rs = 0.783, P < 0.001 in females and rs = 0.911, P < 0.001 in males). Conclusion: The SOS closure degree can be applied for age estimation in the Iranian population. This study presented a method which is highly accurate for age estimation. [ABSTRACT FROM AUTHOR]

Background: Craniopharyngioma (CP) and cranial fibrous dysplasia (CFD) are rare embryonic benign cranial diseases that most commonly present during childhood or adolescence. The coexistence of CP and CFD is extremely rare and has not yet been reported.Methods: We retrospectively reviewed the data of five patients with concomitant CP and CFD treated at Beijing Tiantan Hospital from January 2003 to January 2021 and summarized their clinicopathological features, treatment modalities, and outcomes. We also performed a comprehensive literature review, tested the patients for characteristic GNAS gene mutations related to CFD, and tested the CP specimens for corresponding Gsα protein to explore the potential connection leading to the coexistence of CP and CFD.Results: The cohort comprised four men and one woman (median age, 39 years). The symptoms mainly included headache, dizziness, fatigue, polyuria/polydipsia, hypogonadism, and blurred vision. CFD most commonly involved the sphenoid bone (n = 4). Four patients underwent surgery to remove the CP (one trans-sphenoidal and three transcranial resections); complete and subtotal resection were achieved in two patients, respectively. The tumor subtype was adamantinomatous in three patients and unknown in one. The common postoperative complications were panhypopituitarism, diabetes insipidus, and hypothyroidism. The mean follow-up duration was 57.2 months. Two patients required postoperative hormone replacement therapy. Three patients underwent genetic study of the tumor specimens; GNAS mutations were not detected, but these patients were positive for Gsα protein.Conclusions: Although a definite causative relationship has not been proved, the coexistence of CP and CFD means that potential interplay or an atypical fibrous dysplasia course as uncommon manifestations of CP cannot be excluded. It is more challenging to initiate prompt diagnosis and appropriate treatment for concomitant CP and CFD than for solitary CP because of skull base deformations. Current management strategies are aimed at surgical treating the CP and regularly monitoring the CFD. [ABSTRACT FROM AUTHOR]

Objectives. Recurrent bacterial meningitis (RBM) is a rare but life-threatening disease. This study aims to analyze the clinical features, potential causes, and therapeutic outcomes of RBM in children. Methods. This article retrospectively reviews the clinical characteristics, etiologies, and treatments in children with RBM hospitalized in Hebei children's hospital from 2012 to 2020. Results. A total of 10 children with RBM, five males and five females, were included in this study. The age of RBM in children spans from the neonatal stage to the childhood stage. The underlying illnesses were identified and classified as cerebrospinal fluid rhinorrhea (1 case), humoral immunodeficiency with Mondini dysplasia (1 case), common cavity deformity with cerebrospinal fluid ear leakage (1 case), Mondini malformations (2 cases), incomplete cochlear separation type I with a vestibular enlargement (2 cases), local inflammation of the sphenoid bone caused by cellulitis (1 case), congenital skull base defects (1 case), and congenital dermal sinus with intraspinal abscess (1 case). 6 patients chose targeted therapy for potential reasons. Conclusions. Congenital abnormalities or acquired injuries lead to intracranial communication with the outside world, which can quickly become a portal for bacterial invasion of the central nervous system, resulting in repeated infections. [ABSTRACT FROM AUTHOR]

Purpose: Sella turcica bridging (STB) has significant implications during neurosurgery, since it alters regional anatomy; however, no studies have investigated the global prevalence of STB. Our systematic review aimed to establish the global prevalence of STB, in specimens/individuals with and without comorbidities, in males and females, and of partial, complete, unilateral, and bilateral bridging. Methods: A literature search was conducted in MEDLINE/PubMed, ScienceDirect, and Google Scholar with various key words relating to Sella turcica bridging. Quantitative data were extracted and statistically analysed. Results: Eighty-two studies satisfied our inclusion criteria. The mean prevalence of STB was 26.54%, and most prevalent in Europe. STB was detected more frequently using radiological investigations. STB was less prevalent in healthy individuals (21.12%) when compared to individuals with comorbidities (33.31%). Partial STB was found to be the more prevalent in both individuals with (41.06%) and without (21.55%) comorbidities. The prevalence of unilateral and bilateral STB was only studied in healthy individuals, with unilateral bridging being the more prevalent (6.26% vs 3.84%). Conclusion: The global overall prevalence of Sella turcica bridging in the general population was found to be higher than previously thought. Anatomical and embryological textbooks should consider including information on STB in their texts, due to its considerable prevalence and effects to the regional anatomy. [ABSTRACT FROM AUTHOR]

Purpose: The formation of pterygoalar (Pa) and pterygospinous (Ps) bars are controversial whether they are secondary ossifications with aging or phylogenetic remnant. Therefore we aimed to evaluate the presence of Pa and Ps bars in children on routine cranial computed tomography images. Methods: We retrospectively analyzed the cranial computed tomography images of 500 children under the age of 18. Besides the 0.5 mm axial images, maximum intensity projection and 3D reconstructions were also used. The existence of incomplete or complete Pa and Ps bars were investigated. Results: Incomplete and complete Pa bar was detected in 4.6% and 2.2% of the cases, respectively. Incomplete Ps bar was seen in 13.6% of the cases and complete was in 6%. In total, per 1000 sides, 12 (2.4%) complete and 27 (5.4%) incomplete Pa bars were detected. In the same way, 35 (7%) complete and 88 (17.6%) incomplete Ps bars were seen. The smallest age ossification detected was 5 months old. Additionally, the prevalence of Pa and Ps bars between the under and over 10 years old age groups were statistically significant. Aging increased the prevalence. Conclusion: Considering our results, it seems that the ossification of Pa and Ps ligaments may not be solely related with aging. [ABSTRACT FROM AUTHOR]

This study was performed to compare the orbital and peri-orbital morphological variations in Apert syndrome patients with different cranial vault suture synostosis, so as to provide an anatomic basis for individualized surgical planning. Computed tomography scans of 57 unoperated Apert syndrome patients and 59 controls were subgrouped as follows: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combinations of cranial vault suture synostoses. Orbit bony cavity volume was significantly reduced in type I and type II, by 19% (P < 0.001) and 24% (P < 0.001), respectively. However, the reduction of orbital cavity volume in type III did not reach statistical significance. Globe volume projection beyond the orbital rim, however, increased by 76% (P < 0.001) in type III, versus an increase of 54% (P < 0.001) in type I and 53% (P < 0.001) in type II, due to different ethmoid and sphenoid bone malformations. Maxillary bone volume was only significantly reduced in type I bicoronal synostosis (by 24%, P = 0.048). Both type I and type II developed relatively less zygoma and sphenoid bone volume. Different cranial vault suture synostoses have varied influence on peri-orbital development in Apert syndrome. Instead of mitigating the abnormalities resulting from bicoronal synostosis in type I, additional midline suture synostosis worsens the exorbitism due to a more misshaped ethmoid. [ABSTRACT FROM AUTHOR]

The sphenoid bone development occurs in both prenatal and postnatal periods. Sphenoid bone openings are used as surgical landmarks and are of great importance for neurosurgeons in everyday practice. The aim of this study was to identify morphological characteristics, postnatal development and remodeling, as well as clinical aspect of the sphenoid bone openings and to investigate their relationship and difference in size. The macerated sphenoid bones analyzed in this study were scanned by micro-computed tomography. Areas and distance in-between foramen ovale and foramen rotundum were measured. In addition, different shapes of foramen ovale were described. The most common shape of foramen ovale on both sides was oval, followed by the round, almond and elongated shapes. Modest to strong positive correlations between all foramina and age for the whole sample and both subsamples were presented, except for the right foramen rotundum area in the male subsample, which did not show significant correlation with age. Our study revealed changes in postnatal development and anatomy of foramen ovale and foramen rotundum, primarily in the aspects of size and shape, and should contribute to reducing the risk of damage to neurovascular structures during surgical procedures.

The authors present Tc-99m methylene diphosphonate (MDP) uptake in the right parietotemporal area at whole-body bone scan (WBBS) in 75 years male patient with prostate adenocarcinoma Gleason score 3+4 (pT2N0Mx). No residual or metastatic disease was detected in the patient's Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography four months before WBBS. The patient had undetectable prostate-specific antigen levels and underwent WBBS to restage prostate cancer due to equivocal findings in previous WBBS. Current WBBS planar views revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and the sphenoid bone in addition to equivocal uptake on the lower lumbar vertebrae. Single-photon emission computed tomography study to identify the MDP-avid lesion on the right cranial area revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and sphenoid bone. The patient had a history of transsphenoidal surgery for a hypophyseal tumor two years ago and a recent cerebrovascular event (CVE). Diffusion-weighted magnetic resonance imaging revealed a cortical-subcortical patchy area of restricted diffusion in the parietotemporal region compatible with acute ischemia. Heterogeneous Tc-99m MDP uptake in the right parietotemporal area was attributed to recent CVE and secondary vascular-tissue change-related dystrophic calcification. [ABSTRACT FROM AUTHOR]

PurposeTranssphenoidal pituitary surgery can be carried out with either an operating microscope or with an endoscope, but the relative frequency of both techniques is unknown.MethodsAll microscopic and endoscopic transsphenoidal pituitary surgeries were extracted from the Centers for Medicare and Medicaid Services Part B data files between the years 2003 and 2013. National and state-level trends were compared over time.ResultsEndoscopic surgery significantly increased and microscopic surgery significantly decreased over the years 2003-2013. Thirty-eight of 48 states increased their use of endoscopic surgery, while 38 of 48 states decreased their use of microscopic surgery.ConclusionsNationwide data show a clear trend for an increasing use of endoscopic transsphenoidal surgery at the expense of microscopic surgery. The underlying causes of these trends are unknown, but clearly deserve further investigation.

Background: Plasmacytomas of the skull base are not commonly encountered in clinical practice, with few reported cases in the literature. They form part of the spectrum of plasma cell neoplasms and are classified as a solitary bone plasmacytoma if arising from the sphenoid bone. Its radiographic appearance can lead to misdiagnosis as one of the tumours that are more frequently seen in the skull base, especially meningiomas. Due to the risk of evolution into multiple myeloma, accurate diagnosis is essential. Case presentation: A 56-year-old male presented to the emergency department with rapid proptosis and worsening vision in his right eye for one week's duration. Imaging studies revealed an extra-axial right sphenoid bone tumour with invasion into the temporalis muscle and orbit, leading to significant proptosis. Tumour debulking was done, but there was no improvement in vision postoperatively. Final histology was consistent with a plasmacytoma. The patient was referred to the oncologist for radiation therapy, but subsequently developed further lesions consistent with multiple myeloma. Conclusions: Plasmacytomas need to be considered in the differential diagnosis of skull base tumours. Due to their excellent response to radiation, these patients should have early oncology intervention to prevent irreversible neurological deficits. [ABSTRACT FROM AUTHOR]

Introduction: the foramen venosum (FV) is located in the larger wing of the sphenoid bone and allows the passage of emissary veins that help to balance the intra and extracranial pressure. Knowledge of its morphology and associated structures has an important surgical value. Thus, the aim of this study was to analyze the morphology of FV and its relation to adjacent foramina in Northeast Brazil. This study was conducted using a total of 117 human adult skulls of Federal University of Paraíba were classified by gender, FV type and laterality, being evaluated the diameter of FV, foramen ovale (FO) and foramen spinosum (FS), as well as the distance of FO and FS to FV (DFVFO and DFVFS). Values of p≤0.05 were considered significant. Out of the 117 analyzed skulls, 52 (44.4%) skulls (65 sides, 29 on the right and 36 on the left) presented FV, being 63.46% females and 36.53% males. 33.3% of FV were unilateral and 11.1% were bilateral. The FV were mostly oval (50.7%) and round (49.3%) types. Mean diameter of FV was 3.56±0.7mm, FO 7.88±1.16mm, FS 4.01±0.39mm, DFVFO 8.18±1.09mm and DFVFS was 14.54±1.68mm. Only FO (p=0.009) and FS (p=0.001) had significant differences between genres, and DFVFO had among sides (p=0.021). FV has a high prevalence in Northeast Brazil, predominantly in women on the left side with oval and round types. Its relation with other foramina showed differences among genres and sides. This shows the relevance of the FV study to minimize the risk of iatrogenic injury during surgical interventions in this region. [ABSTRACT FROM AUTHOR]

Background: Sphenoid sinus is the most inaccessible paranasal sinus, enclosed within the sphenoid bone and intimately related to numerous vital neural and vascular structures. Anatomic variation of the sphenoid sinus is well documented and may complicate surgery in such a place. Objective: To assess the reliability of preoperative computed tomography (CT) in determination of the distance between the posterior wall of maxillary sinus (PWMS) and the sphenoid sinus ostium (SSO) in the coronal plane. Patients and methods: This was a prospective study of the distance between the SSO and the PWMS in the coronal plane, which was measured both radiologically in preoperative CT and intraoperatively during endoscopic sinus surgery for patients in need for middle meatal antrostomy and sphenoid sinusotomy at the same side. Distances obtained by both techniques have been tested for the degree of correlation. Number of the included patients was 25. Results: Forty four nasal sides were included in the study. The mean distance between the sphenoid sinus ostium and posterior wall of maxillary sinus in the coronal plane was 6.6 ± 1.8 mm when measured by preoperative CT and 6.9 ± 1.9 mm when measured directly during surgery. No significant difference was found between the mean distances measured by both techniques (p = 0.246) with good agreement between them (r = 0.864). Conclusion: Preoperative CT may be a reliable tool to preoperatively determine the difference in depth between the PWMS and the SSO. [ABSTRACT FROM AUTHOR]

Purpose: We sought to define the locoregional extension patterns of nasopharyngeal carcinomas (NPCs) by positron emission tomography (PET)/magnetic resonance imaging (MRI) and to improve clinical target volume (CTV) delineation. Methods: Between May 2017 and March 2021, 331 consecutive patients with nonmetastatic NPCs who underwent pretreatment, simultaneous whole-body PET/MRI for staging were included in this study. Results: The high-risk regions included the base of the sphenoid bone, the prestyloid compartment, prevertebral muscle, foramen lacerum, medial pterygoid plate, sphenoidal sinus, clivus, petrous apex, and foramen ovale. When the high-risk regions were invaded, the incidence rates of tumor invasion into the medium-risk regions increased. In contrast, when the high-risk regions were not involved, the incidence rates of tumor invasion into the medium-risk regions were mostly less than 10%, excluding the post-styloid compartment and oropharynx. According to the updated consensus guidelines of the neck node levels for head and neck tumors from 2013, level IIa (77.3%, 256/331), level IIb (75.8%, 251/331), and level VIIa (71.3%, 236/331) were the most frequently involved levels, followed by levels III (42.6%), Va (13.9%), IVa (8.8%), IVb (3.6%), Ib (3.6%), Vb (2.4%), VIIb (2.4%), VIII (1.8%), Vc (0.9%), and Xa (0.3%). Skip lymph node metastasis occurred in only 1.9% of patients. Conclusions: For NPCs, primary disease and regional lymph node spread follow an orderly pattern, and a skip pattern of lymph node metastasis was unusual. Involved level radiotherapy might be feasible for cervical lymph node levels below the caudal border of cricoid cartilage and level VIIb. [ABSTRACT FROM AUTHOR]

A sample comprised by 53 dry modern skulls of adult small ruminants (sheep n = 36 and goat n = 17) from a comparative collection, absent of bony pathologies, was studied on their basal craniofacial aspect. A total of 26 points (2 sagittal landmarks and 24 semilandmarks) and 32 points (4 landmarks and 28 semilandmarks) were chosen on the sphenoid bone and palatine bone respectively and analysed by means of geometric morphometric techniques. The interaction of individuals and sides (fluctuating asymmetry) showed a highly significant difference for both bones, as well as side effect (directional asymmetry), being levels of detected fluctuating asymmetry higher in sphenoid (25.4%) than in palate (12.8%). Asymmetric component differentiated sheep and goats. Detected basicranial asymmetry can be viewed as a common finding among small ruminants. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Meningiomas in bone are rarely subjected to fine-needle aspiration diagnosis, and those arising in the skull bone with a cystic presentation are rare. A 24-year-old woman presented with subdural hemorrhage, and subsequent radiology depicted an osteolytic mass-like lesion in the sphenoid bone. Intraoperatively, a solid and cystic hemorrhagic lesion mimicking an aneurysmal bone cyst was observed in the sphenoid bone with dural tearing. Frozen cytology showed singly scattered or epithelioid clusters of round to elongated cells intermixed with many neutrophils. Tumor cells had bland-looking round nuclei with rare prominent nucleoli and nuclear inclusions and eosinophilic granular to globoid cytoplasm in capillary-rich fragments. Histology revealed intraosseous meningothelial and microcystic meningioma (World Health Organization grade 1) in right lesser wing of the sphenoid bone. Considering its unusual location and cytologic findings, differential diagnoses included chordoma, chondroma, chondrosarcoma, and aneurysmal bone cyst. The present case posed a diagnostic challenge due to possible confusion with these entities.

Background: Forensic age estimation is a procedure which utilises many methods to estimate the age of both living and deceased individuals, including those who have died in natural disasters or man-made catastrophes. The pattern and closure of spheno-occipital synchondrosis (SOS) fusion, along with subchondral ossification of the mandibular condyle, can be used to estimate age., Aim and Objectives: This study aims to estimate age using computed tomographic (CT) images of spheno-occipital synchondrosis fusion (SOS) and mandibular condylar cortication (MCC), and to correlate these findings with chronological age., Materials and Methods: The present study included 435 CT images of individuals aged 10-25 years. SOS fusion was assessed using a four-stage system, and MCC was assessed bilaterally using a three-stage system on the sagittal plane. Data on fusion stages and cortication types were entered along with chronological age, and then statistically analysed., Results: SOS fusion stage 2 occurred at similar age in males (19.82 ± 2.67 years) and females (19.23 ± 2.93 years). Earlier fusion of other stages was observed in females by a mean age of 2 years. MCC was completed 1 year earlier in females, with statistically significant differences (p ≤ 0.001). When comparing cortication types and different fusion stages, only type II cortication showed statistically significant differences compared to different fusion stages (p ≤ 0.001)., Conclusion: Mandibular condylar cortication (MCC) and spheno-occipital synchondrosis (SOS) fusion were positively correlated with chronological age, suggesting that these parameters can be used as an adjunct method for age estimation., Competing Interests: The authors report no conflicts of interest in this work., (Copyright© 2024 IOFOS This work is published and licensed by International Organization for Forensic Odonto-Stomatology.)

Arachnoid cysts can be intra-cranial or along the spinal cord. Intracranial arachnoid cyst is a very rare finding, trauma being the leading case of it. It is extremely rare for the development of intra-diploic arachnoid cyst without a traumatic history. We present a case of an intra-diploic arachnoid cyst communicating with the greater wing of the sphenoid and in close proximity to the cavernous sinus in a known case of Wilson disease for 22 years. Due to its low incidence, there is a gap in the knowledge and discussion of this cystic lesion, its pathophysiology and management, which are discussed in this case report., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Purpose: To describe the relation of the sphenoid ridge (SR) with the surrounding anatomical structures in healthy children when approaching the anterior and middle fossae., Methods: Computed tomography of 180 pediatric patients (90 males / 90 females), aged 1-18 years were included the study. The size of the lesser wing (LW) and the distances of the LW to certain landmarks were measured., Results: The LW length was 28.48 ± 8.15 mm. The LW widths at the midline and the midpoint and lateral point of the SR were 7.78 ± 1.74 mm, 2.84 ± 0.81 mm, and 1.91 ± 0.64 mm, respectively. The distance between the midpoint of the SR and the crista galli was 28.22 ± 5.56 mm, and the distance between the crista alaris and internal auditory meatus was 51.73 ± 5.79 mm. The linear function was calculated as y = 18.748 + 1.024 × age for SR length, y = 6.046 + 0.182 × age for the midline width of SR, y = 2.367 + 0.050 × age for the midpoint width of SR, y = 1.249 + 0.069 × age for the crista alaris width, y = 21.727 + 0.683 × age for the distance between the SR midpoint and the crista galli, and y = 43.614 + 0.855 × age for the distance between the crista alaris and internal auditory meatus., Conclusion: All measured parameters increased irregularly with advancing age. Furthermore, our regression equations representing the growth dynamics of SR may be used to estimate these parameters., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The foramen spinosum, one of the important openings at the base of the cranium, is the opening through which the middle meningeal artery enters the cranium. The variations of the foramen spinosum should be well known to be an important landmark in middle fossa surgeries and to understand better the clinical conditions related to the middle meningeal artery passing through it. A total of 35 bones (32 cranial base and 3 separate sphenoid bones) of individuals of unknown age, sex, and ethnicity in the Laboratory of the Department of Anatomy, Gaziantep University, Faculty of Medicine were examined bilaterally in this study. One of the 35 bones was found to have a duplicated foramen spinosum on the left side and an absence foramen spinosum on the right side. Foramen spinosum variations should be considered in middle fossa approaches and procedures involving the middle meningeal artery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The aim of the present study was to examine the growth dynamics of the two ossification centers of the body of sphenoid bone in the human fetus, based on their linear, planar and volumetric parameters. The examinations were carried out on 37 human fetuses of both sexes aged 18-30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction and statistical methods, we evaluated the size of the presphenoid and postsphenoid ossification centers. The presphenoid ossification center grew proportionately in sagittal diameter, projection surface area and volume, and logarithmically in transverse diameter. The postsphenoid ossification center increased logarithmically in sagittal diameter, transverse diameter and projection surface area, while its volumetric growth followed proportionately. The numerical findings of the presphenoid and postsphenoid ossification centers may be considered age-specific reference values of potential relevance in monitoring the normal fetal growth and screening for congenital disorders in the fetus. The obtained results may contribute to a better understanding of the growing fetal skeleton, bringing new numerical information regarding its diagnosis and development., (© 2024. The Author(s).)

Introduction: To study the rare and unusual causes of monocular elevation deficit., Methods: Five patients presenting to us with diplopia and elevation deficit were thoroughly examined and were found to have monocular elevation deficit due to rare causes., Observations: All five were found to have different underlying etiologies - iatrogenic, sphenoid wing meningioma, cysticercosis, sarcoidosis and mid brain infarct, and were managed appropriately., Discussion: Monocular Elevation Deficit can occur due to a variety of causes. Having a high index of suspicion for the more serious etiologies is of utmost importance. Thorough clinical examination and imaging help clinch the diagnosis.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The continuous development of microsurgical techniques to treat lesions in and around the optic canal (OC) emphasizes the need for an accurate understanding of the microanatomy of the region. Forty anatomic specimens were studied, with emphasis on the OC. The sphenoid bone and related structures were decalcified, added to animal gelatin, cut into 1-mm thick slices, and observed through a surgical microscope. The OC was considered the course that contained exclusively the optic nerve (ON) and ophthalmic artery. The mean distance between the medial walls of the OC was 12.2 mm, and the OC had an average length of 12.06 mm. The OC has a horizontal oval shape in the proximal (internal) segment; a round shape in the middle segment; and a vertical oval shape in the distal (external) segment at the orbital cavity. In the middle segment of the OC, the thickest wall of the OC was the lateral (average: 0.68 mm), while the medial, inferior, and superior wall measures had averages of 0.75, 0.40, and 0.39 mm, respectively. The lateral wall of the sphenoid sinus is located under the OC, and the inferior wall of the OC separates both structures. The ophthalmic artery inside the OC was always located under the ON, between the dural sheaths, and had an average diameter of 1.03 mm. The neurovascular structures within the OC vary in size and shape. The anatomic knowledge of the OC and its variations allows better surgical results and minimizes the surgical morbidity. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between extraocular muscle expansion and proptosis reduction (Δproptosis) in patients with thyroid eye disease who underwent deep lateral orbital wall decompression and to analyze the factors that contribute to extraocular muscle expansion. Methods: This retrospective, observational study included 133 sides from 77 patients with thyroid eye disease. The cross-sectional areas of the greater wing of the sphenoid bone (trigone), extraocular muscles, and superior ophthalmic vein were measured on computed tomographic images. Variables influencing Δproptosis were analyzed using multivariate linear regression analyses with stepwise variable selection. Predictive factors for the rate of postoperative increase in the cross-sectional extraocular muscle areas (Δextraocular muscle) were analyzed using the same statistical method. Results: The amount of orbital fat removed (P < 0.001) and rate of Δlateral rectus muscle (P < 0.001) were positively and negatively correlated with Δproptosis, respectively (r = 0.425; adjusted r2 = 0.168; P < 0.001). The cross-sectional trigone area (P < 0.001) was positively correlated with the rate of Δlateral rectus muscle, whereas the preoperative cross-sectional lateral rectus muscle area (P < 0.001) and amount of orbital fat removed (P = 0.036) were negatively correlated with the rate of Δlateral rectus muscle (r = 0.551; adjusted r2 = 0.288; P < 0.001). Conclusion: Lateral rectus muscle expansion was negatively correlated with proptosis reduction and proved to be predictable before surgery. The results of this study will help predict proptosis reduction after deep lateral orbital wall decompression and to preoperatively plan additional orbital bony and fat decompression. [ABSTRACT FROM AUTHOR]

Aim: To investigate differences in sella turcica size and bridging in children with unilateral cleft lip and palate (UCLP) with or without concomitant dental anomalies. Patients and Methods: A cross-sectional study was carried out looking at 56 children with nonsyndromic UCLP. Lateral cephalograms, taken before alveolar bone grafting, were used to assess sella turcica height, width, area, and bridging. Panoramic radiographs were used to evaluate the presence of dental anomalies in the cleft area including agenesis, supernumerary, and peg-shaped lateral incisors. Differences between sella turcica measurements in the presence or absence of dental anomalies were assessed using t tests. Differences between the prevalence of dental anomalies and sella turcica bridging were assessed using χ2 and Fisher exact tests. Multinomial logistic regression was used to investigate potential associations between sella measurements and dental anomalies. Results: Twenty-six of the 56 children presented with agenesis of the cleft-side lateral incisor, while 7 had a supernumerary, and 19 had a peg-shaped lateral incisor. With regard to sella turcica bridging, 27 children had no calcification, 25 partial and 4 complete calcification. Children with agenesis of the cleft-side lateral incisor showed a shorter sella maximum height (P =.010) and a smaller area (P =.019). When looking at sella turcica bridging, 100% of children with complete calcification showed agenesis of the cleft-side lateral incisor, compared with 52% and 33% of children with partial calcification and no calcification, respectively (P =.034). Conclusions: Children with UCLP and sella turcica bridging are more likely to present with agenesis of the cleft-side maxillary lateral incisor. [ABSTRACT FROM AUTHOR]

Background: Finding an aneurysmal bone cyst in the skull is rare and for a neurosurgeon to come across such lesions in the sphenoid bone with orbital extension is even rarer. Case presentation: We report a case of a 16-year female who presented with a three-month history of headache, proptosis, and deterioration of vision. Pre-operative imaging studies which included NCCT head and MRI brain, suggested the lesion to be an aneurysmal bone cyst of the greater wing of the sphenoid, with extension into the orbit. Intraoperative findings did corroborate with the preoperative imaging findings and were again confirmed later from the histopathology report. Conclusion: Aneurysmal bone cysts of sphenoid bone with orbital extension, though rare, can be excised completely, without hampering the cosmesis. Being benign, patients can have a prolonged recurrence-free period if the lesion is completely excised. [ABSTRACT FROM AUTHOR]

Background: Enterococcus faecalis (E. faecalis) meningitis is a rare disease, and most of its occurrences are of post-operative origin. Its rapid diagnosis is critical for effective clinical management. Currently, the diagnosis is focused on cerebrospinal fluid (CSF) culture, but this is quite limited. By comparison, metagenomic next-generation sequencing (mNGS) can overcome the deficiencies of conventional diagnostic approaches. To our knowledge, mNGS analysis of the CSF in the diagnosis of E. faecalis meningitis has been not reported.Case Presentation: We report the case of E. faecalis meningitis in a 70-year-old female patient without a preceding history of head injury or surgery, but with an occult sphenoid sinus bone defect. Enterococcus faecalis meningitis was diagnosed using mNGS of CSF, and she recovered satisfactorily following treatment with appropriate antibiotics and surgical repair of the skull bone defect.Conclusions: Non-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and mNGS technology could be helpful in diagnosis in the absence of a positive CSF culture. [ABSTRACT FROM AUTHOR]

Background: Ewing's sarcoma (ES) is a malignancy that arises from bones or soft tissue, characterized by primitive small and round blue cells. Primary ES typically occurs in the long bones, vertebrae, or pelvis, and is extremely rare in the skull base. Case Description: A 14-year-old girl presented with posterior cervical pain and dysfunction of multiple cranial nerves (CNs). Radiological investigation revealed a solid mass of the petroclival bone extending into the sphenoid sinus. The patient underwent endoscopic transsphenoidal surgery for diagnosis of the pathology, and partial resection was safely achieved. Histopathological, genetic, and radiological examinations confirmed the diagnosis of primary ES. Subsequently, the patient underwent adjuvant chemotherapy and radiotherapy following which the clinical symptoms resolved. Complete response was achieved after multimodal treatment. Twenty months after treatment, the patient remains in remission without recurrence or metastatic disease. Primary ES of the petroclival bone has been reported in only three cases in the literature. As seen in the present case, dysfunction of multiple CNs is the most common manifestation of petroclival ES. Diagnosis should be confirmed by histopathological and genetic examinations considering the nonspecific clinical symptoms and radiological features. Conclusion: Multimodal treatment, including surgery, chemotherapy, and radiotherapy, can result in favorable outcomes. Clinicians should consider safe resection during surgical management to prevent complications that can delay postoperative multimodal treatment. [ABSTRACT FROM AUTHOR]

Ossifying fibroma (OF) is an uncommon benign fibro-osseous lesion. Based on its clinical, morphological, and radiological features, OF is further divided into cemento-ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), and juvenile trabecular ossifying fibroma (JTOF). JPOF rarely involves the cranial base, with limited reports published on spheno-orbital JPOF. In this paper, we report a case of JPOF of the greater wing of the sphenoid bone and lateral orbital wall in an 11-year-old child and show a surgical video. Although rare, JPOF should be considered in the differential diagnosis of fibro-osseous lesions of the spheno-orbital region. [ABSTRACT FROM AUTHOR]