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Skull Defect (skull + defect)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Use of the Vacuum-Assisted Closure Device in Enhancing Closure of a Massive Skull Defect,

THE LARYNGOSCOPE, Issue 6 2004
Umesh S. Marathe MD
Abstract Objectives/Hypothesis: The objective was to describe a novel technique for reconstructing the cranial vertex without the use of free tissue transfer. Study Design: Case report, literature review, and discussion. Methods: A 50-year-old woman presented from a remote Pacific Island community with a 12 × 14-cm, necrotic, grossly contaminated eccrine gland carcinoma of the cranial vertex that extended through the calvarium but did not invade the dura. Following tumor extirpation, the resulting bony defect was 10 × 12 cm in size, with a concomitant scalp defect of 14 × 16 cm. Free tissue transfer was impossible because of severe intimal peripheral vascular disease, posing a challenging reconstructive dilemma. After tumor resection, the bony edges were covered with local scalp flaps and the vacuum-assisted closure device was placed over the wound at a constant setting of ,50 mm Hg. The vacuum-assisted closure device was changed three times per week for 3 weeks. Results: A thick, 1-cm bed of granulation tissue developed over the dura, allowing temporary coverage by a split-thickness skin graft, and the scalp defect decreased in size by approximately 25%. The patient did not develop meningitis, headache, or localized infection as a result of placement of the vacuum-assisted closure device and tolerated the vacuum-assisted closure well. After a requisite period of healing, tissue expanders and calvarial reconstruction will be performed. Conclusion: Use of the vacuum-assisted closure device is a safe, reliable adjunct in the closure of large cranial defects with exposed dura and offers a novel reconstructive option for complex defects of the head and neck. [source]

Scaffold Modeling Application in the Repair of Skull Defects

ARTIFICIAL ORGANS, Issue 4 2010
Weibing Wan
Abstract The repair of large segmental bone defects caused by trauma, inflammation, and surgery on tumors pose a major clinical challenge. Tissue-engineered bone is emerging as a good choice for prefabricating cellular scaffold, and computer-aided technologies and medical imaging have created new possibilities in biomedical engineering. An accurate and efficient construction of anatomic models is critical to the application of these computational methods. Such models must be validated prior to application. In this article, we explore the potential of combining these techniques to scaffold and repair a pediatric skull. Working under the hypothesis that the autogenously cultivated osteoblasts can be grown on individualized scaffolds to improve bone regeneration in skull defects, we focus our study on potential problems concerning the segmentation, reconstruction, and mesh simplification for a pediatric skull. We also propose a new framework to improve the accuracy of the model entity from image segmentation to mesh simplification. [source]

Orthostatic Headaches in the Syndrome of the Trephined: Resolution Following Cranioplasty

HEADACHE, Issue 7 2010
Bahram Mokri MD
Objective., To draw attention to the syndrome of the trephined as a potential cause for orthostatic headaches without cerebrospinal fluid (CSF) leak. Background., Orthostatic headaches typically result from CSF leaks but sometimes may occur in conditions without any evidence of CSF leakage. Methods., A 37-year-old right-handed woman became comatose after a motor vehicle accident with cerebral contusions and massive left cerebral edema. A large frontoparietal craniectomy was carried out. In 5 months, she made good neurologic recovery. Freeze-preserved bone flap was placed back. In several weeks she was functionally near normal. Two years later, she began to complain of orthostatic headache and gradually additional manifestations appeared including progressive gait unsteadiness, imprecise speech, cognitive difficulties, and an increasing left hemiparesis along with progressive sinking of the skull defect and shift of the midline and ventricular distortion. She underwent removal of resorptive sinking bone flap and construction of an acrylic cranioplasty. Results., At 6-month follow-up, there was complete resolution of the orthostatic headaches, remarkable neurologic improvement along with resolution of midline shift and ventricular distortion. Conclusion., The syndrome of the trephined is yet another cause of orthostatic headaches without CSF leak. [source]

Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma,

THE LARYNGOSCOPE, Issue 7 2008
Aldo C. Stamm MD
Abstract Objectives/Hypothesis: To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma. Study Design: Observational retrospective cohort study. Methods: Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow-up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach). Results: Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation ± 16.3). Mean tumor size was 3.2 cm (standard deviation ± 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs. Conclusions: The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near-field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two-surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach. [source]

Aplasia cutis congenita with skull defect in a monozygotic twin after exposure to methimazole in utero

BIRTH DEFECTS RESEARCH, Issue 10 2007
Hideyuki Iwayama
Abstract BACKGROUND: Aplasia cutis congenita (ACC) is a condition in which localized or widespread areas of skin are absent at birth. Defective lesions show complete absence of all layers of skin, occasionally extending to skull or dura. ACC is etiologically heterogeneous; many different etiologies including teratogens have been documented. CASE: We describe the first reported case of a monozygotic twin with ACC after exposure to methimazole in utero. The female patient was born at 36 weeks gestation as the first child of monozygotic twins. The mother received methimazole between the 11th and 17th weeks of pregnancy because of transient hyperthyroidism. The second child did not have ACC. The patient had defects of the scalp, skull, and dura (7 × 5 cm) on the sagittal line of the parieto-occipital region. No other malformations were noted. The scalp defect has been treated daily with sterile physiological saline and petrolatum dressing in addition to intravenous antibiotics. Trafermin, a recombinant human fibroblast growth factor, was sprayed from day 6 to promote epithelialization of the scalp defect. On day 21, she had high fever due to infection of the defect lesion, which was controlled by povidone iodine dressing and intravenous antibiotics. The defect of the scalp was well healed after 6 weeks, but the skull defect remained unclosed. CONCLUSIONS: We describe a rare case of a monozygotic twin with ACC and skull defect after methimazole exposure in utero. The findings of our case suggest that methimazole is a potential teratogen of ACC. Birth Defects Research (Part A) 2007. © 2007 Wiley-Liss, Inc. [source]

Hemispheric brain volume replacement with free latissimus dorsi flap as first step in skull reconstruction

MICROSURGERY, Issue 4 2005
Anton H. Schwabegger M.D.
Large skull defects lead to progressive depression deformities, with resulting neurological deficits. Thus, cranioplasty with various materials is considered the first choice in therapy to restore cerebral function. A 31-year-old female presented with a massive left-sided hemispheric substance defect involving bone and brain tissue. Computed tomography showed a substantial convex defect involving the absence of calvarial bone as well as more than half of the left hemisphere of the brain, with a profound midline shift and a compression of the ventricular system. There was a severe problem due to multiple deep-skin ulcerations at the depression margin, prone to skin perforation with a probability of intracranial infection. In a first step, a free myocutaneous latissimus dorsi flap was transplanted for volume replacement of the hemispheric brain defect, and 4 months later, artificial bone substitute was implanted in order to prevent progressive vault depression deformity. Healing was uneventful, and the patient showed definite neurological improvement postoperatively. Free tissue transfer can be a valuable option in addition to cranioplasty in the treatment of large bony defects of the skull. Besides providing stable coverage for the reconstructed bone or its substitute, it can also serve as a volume replacement. © 2005 Wiley-Liss, Inc. Microsurgery 25:325,328, 2005. [source]