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Primary intraosseous cavernous hemangiomas of the skull are very rare in the pediatric age group and usually slow-growing tumors. We present a case of 5-month-old girl with a left occipital cavernous hemangioma that is rapidly growing. The subcutaneous occipital tiny mass was first noted at birth, and the lesion became rapidly enlarged in size and became soft for 3 months. The left occipital subcutaneous lesion was 4.0 × 4.0 × 2.0 cm (AP × LR × HT) in size. There was no history of trauma or bone tumor in her family. She underwent resection of the lesion, and a pathologic diagnosis of calvarial cavernous hemangioma was made. No recurrence was seen 1 year after surgery. The rapid growth of the infant cavernous hemangioma might be related to not only bleeding and/or congestion of the lesion but the immature thin skull of the infant.

Several surgical procedures have been described to correct the deformities associated with craniosynostosis. To simplify the prediction of results, virtual planning techniques and image-guided surgery have been used. Digital planning can be transferred to the operating room using osteotomy and cutting guides or surgical navigation. We describe a novel bone fixation method that allows for anchoring of a cranial dynamic reference frame (DRF) in a steady manner. DRF can be used for registration and as a reference for surgical navigation in an infant's skull. We describe this novel technique to overcome the problems of DRF fixation on an infant's thin and weak calvarium. We fixed the DRF to the cranium using this new system. A 6-hole X-shaped miniplate was placed using 5 screws, leaving 1 of the central holes free. The self-drilling screw that anchors the DRF in position was placed in the free central hole, avoiding calvarial bone breakage and allowing for surgical navigation. To the best of our knowledge, the present study is the first report of this DRF anchorage modification for surgical navigation during surgery of craniosynostosis in an infant.

Rheumatologists are often called to be independent examiners of injured claimants and to address the question: "What is causing the injured person's symptoms?" This article deals with the legal principles that arise in these cases, including causation, convenient focus, secondary gain, and thin skull rules. We shall first set out two hypothetical scenarios of personal injury cases that set the scene for a discussion of legal principles in personal injury law. With the same two scenarios of personal injury in mind, we shall review the legal principles and the biopsychosocial models of the illnesses concerned and consider the importance of examiners going beyond diagnostic labels towards a more in-depth analysis of illness factors and mechanisms that in turn assist the trier of facts.

A Jehovah’s Witness suffers severe injuries in an automobile accident, and these injuries result from another person’s negligent driving. The victim refuses to accept standard medical treatment, which includes blood transfusions. Had she accepted standard treatment, the victim would have been returned to a near normal life. As a result of her decision, she now faces the prospect of life in a wheel-chair. Should the tortfeasor be held liable for the additional damages that result from the victim’s religious decision, or should the victim’s religious choice be treated as a failure of reasonable mitigation? I support the former option, arguing that the thin skull rule should be extended to include religious choices such as the refusal of blood transfusions. Our constitutional commitments to religious freedom and equality require us to treat these choices as reasonable ones, and this supports the notion of religious thin skulls. The argument provided here fits neatly with the structure of tort, and with the major Canadian precedents regarding the evaluation of victim behaviour.

Background/Aims: Infants are especially at risk for intracranial injuries from dog bites due to their small stature and thin skull. Only 21 case reports have been published in the literature. We aim to add knowledge and treatment recommendations based on a more substantial sample. Methods: Ten pediatric patients with a penetrating skull injury as a result of a dog bite, treated at our institution between 1992 and 2010, were identified and analyzed descriptively. A literature review of the 21 case reports was also conducted. Results and Conclusion: Early diagnosis and treatment can prevent complications from hemorrhage or infections. Based on our results, we recommend obtaining a head CT for all victims sustaining injuries to the head, early use of broad spectrum antibiotics, debridement and irrigation of tissue, and follow-up to identify late infectious complications.

Laser speckle contrast imaging (LSCI) is a powerful tool capable of acquiring detailed maps of blood flow in arteries and veins on the cortical surface. Based on the blurring of laser speckle patterns by the motion of blood cells, LSCI can be combined with a variety of optical imaging preparations to acquire high-spatiotemporal resolution images of blood flow, and track changes in blood flow over time, using relatively simple instrumentation. Here, we describe methods for LSCI of cerebral blood flow via a thin skull imaging preparation in mice or rats. This preparation allows precise semiquantitative mapping of changes in blood flow over time using straightforward surgical protocols and equipment.

We show that changes in cerebral blood flow can be accurately estimated using the new Multi Exposure Speckle Imaging instrument. We also show that these estimates are unaffected by the presence of thin skull.

Halo application is a standard method for cervical immobilization. However, complications may occur in children because of their thin skull and immature bone. The authors report two cases of odontoid fracture in preschool children treated with a Minerva cast. Two 4-year-old children sustained displaced odontoid fractures in motor vehicle accidents. The fractures were immediately reduced and immobilized using a Minerva cast, followed by the application of a soft collar. By the 1-year follow-up, uneventful bone union had occurred, and the children were able to attend preschool with minimal or no neurologic deficits. The Minerva cast is a classic, inexpensive method of cervical immobilization and is still useful for this kind of fracture. Immediate reduction and immobilization with a Minerva cast is a viable option for displaced odontoid fractures in preschool children.

This report describes a chronically fixed stereotaxic device for intracerebral stimulation and recording in waking animals. It provides a virtually closed system for exploration of the brain and is particularly useful for animals in which a thin skull presents difficulties in securing cranial attachments.

Most animal eyes feature an opaque pigmented eyecup to assure that light can enter from one direction only. We challenge this dogma by describing a previously unknown form of eyeshine resulting from light that enters the eye through the top of the head and optic nerve, eventually emanating through the pupil as a narrow beam: the Optic-Nerve-Transmitted (ONT) eyeshine. We characterize ONT eyeshine in the triplefin blenny Tripterygion delaisi (Tripterygiidae) in comparison to three other teleost species, using behavioural and anatomical observations, spectrophotometry, histology, and magnetic resonance imaging. The study’s aim is to identify the factors that determine ONT eyeshine occurrence and intensity, and whether these are specifically adapted for that purpose. ONT eyeshine intensity benefits from locally reduced head pigmentation, a thin skull, the gap between eyes and forebrain, the potential light-guiding properties of the optic nerve, and, most importantly, a short distance between the head surface and the optic nerves. The generality of these factors and the lack of specifically adapted features implies that ONT eyeshine is widespread among small fish species. Nevertheless, its intensity varies considerably, depending on the specific combination and varying expression of common anatomical features. We discuss whether ONT eyeshine might affect visual performance, and speculate about possible functions such as predator detection, camouflage, and intraspecific communication.

To the Editor.— Alker et al's report "Radiology of a Large Cisterna Magna Cyst" (Archives36:376-379, 1979) describes an 18-year-old woman admitted for seizures and headaches. A pneumoencephalogram showed a huge cystic structure in the posterior fossa that was thought to be a dilated cisterna magna. They believed that the cyst was acting as a mass lesion exerting pressure on posterior fossa structures without causing hydrocephalus. At the time of operation, some evidence of "long-standing pressure" was noted. After surgery, the seizures and headaches disappeared. They mentioned that such marked enlargement of the cisterna magna is rare. We reported 1 the incidence of "mega cisterna magna" in 3,000 computerized tomography (CT) scans and found 11 such cases. One of our cases also had a thin skull in the area of the cyst. In two cases, surgical intervention gave no symptomatic relief. We believed it was most likely that the mega

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