多发性颅骨内血管瘤一例报告并文献复习

目的探讨多发性颅骨内血管瘤的临床特征和预后。方法报告1例多发性颅骨内血管瘤病例,结合相关文献分析该疾病的X线、CT、MRI和DSA等临床特征,探讨治疗效果和预后。结果多发性颅骨内血管瘤临床上极为罕见,大约占所有骨肿瘤的0.2%。X线平片检查见整个颅骨内蜂窝状改变,CT、MRI显示颅骨溶骨性病变或糜烂并向颅内外发展,DSA造影病变无染色,病理显示大小不等的异常血管,骨结构异常以及出血征象。外科治疗效果不佳。结论多发性颅骨血管瘤为颅骨内破坏性病变,涉及整个颅骨的多发性颅骨血管瘤,外科治疗效果不佳。     

Neo-Adjuvant Chemotherapy Followed by Surgery for Extensive Calvarial Metastases of a Neuroblastoma

Neuroblastoma is a common tumor of children. We report a patient with extensive calvarial metastases of a neuroblastoma as an initial presentation. A 2-year-old girl presented with a history of gradually increasing head size and fever. A brain CT showed a multilobulated, large, extra-axial tumor involving both frontotemporoparietal areas with a sunray-spiculated hyperostosis of the skull and marked contrast enhancement. A brain MRI demonstrated extensive calvarial lesions with simultaneous involvement of the orbits. A biopsy was performed and a ganglioneuroblastoma was diagnosed. On systemic evaluation, an enlarged abdominal mass was detected. After neo-adjuvant chemotherapy, most of the tumors disappeared except for a tumor in the left parietal area; there was a corresponding decrease in the circumference of the head. We performed surgery for the remnant mass. Intensive chemotherapy was administered and a bone marrow transplantation was performed. Adequate neo-adjuvant chemotherapy followed by surgery to the neuroblatoma with extensive metastases to the skull and orbit may be helpful.     

Calvarial dermoids and epidermoids in infants and children: sonographic spectrum and follow-up

Objective  Dermoids and epidermoids are defined as ectodermal inclusion cysts. The aim of this study was to evaluate the spontaneous natural behavior and the ultrasonographic appearance of calvarial dermoids and epidermoids. Materials and methods  The ultrasonographic image datasets of 100 consecutive children up to 4 years of age (52 females, 48 males; age range at first examination 1 week to 40 months, mean age 8.3 ± 6.9 months) presenting with a firm palpable calvarial mass (103 lesions) were studied retrospectively. All ultrasound (US) examinations were performed using a 7- to 10-MHz linear transducer including B-mode and color Doppler sonography. US follow-up studies (up to 47 months) could be achieved in 30 patients with 33 lesions. Results  At first presentation, all 103 lesions demonstrated very similar US features: a round or oval configuration (diameter 3–18 mm), hypoechogenic, and homogeneous internal structures with a marked hyperechogenic superficial capsule, which were localized adjacent to or expanded into the osseous external calvarial table. No conspicuous flow signs on color Doppler were seen. In 33 lesions with US follow-up investigations, 49% showed variable signs of regression: reduction of size, increase of internal echogenicity, and decrease of demarcation. Eight lesions (24%) remained unchanged. A slight progression up to a maximum diameter of 17 mm but without any increase in osseous destruction was observed in the remainder (27%). There was no lesion with a complete destruction of the underlying bone and no intracranial extension in any of the cases. Conclusions  Calvarial dermoids and epidermoids in infants and children show a benign natural behavior with spontaneous regression in a large number of cases. On US, they demonstrate uniform pathognomonic features enabling the correct diagnosis in any of those lesions. Thus, additional, mainly radiation burdening and sometimes misleading imaging techniques should be restricted. Surgical treatment protocols should be handled conservatively and lesions should be primarily followed-up clinically and by US. Thomas Riebel and Siegfried David contributed equally to this study.     

Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) ? 0.13, 95% confidence interval (CI) ? 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD ?2.32, 95% CI ?5.20 to 0.55, P = 0.113; late postoperative: MD ?0.01, 95% CI ?0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28–100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.     

Role of carbonic anhydrase in bone resorption: Effect of acetazolamide on basal and parathyroid hormone-induced bone metabolism

Summary The effects of the carbonic anhydrase inhibitor acetazolamide on basal and parathyroid hormone (PTH)-induced bone metabolism were studied to evaluate the manner in which acetazolamide inhibits bone resorption. Half-calvaria from 5 to 6-day-old mice were cultured using the following treatments: control; acetazolamide (10, 33, or 100 μM); PTH (16.7 nM bovine PTH 1-34); acetazolamide + PTH. The effects of acetazolamide on PTH-induced cAMP accumulation and protein synthesis were determined. Media from bones cultured for 48 hours were analyzed for calcium to assess bone resorption, glucose to assess calvarial glucose utilization, and lactic acid to assess calvarial lactic acid release. Media were also assayed for β-glucuronidase activity as an indicator of lysosomal enzyme release and for lactate dehydrogenase activity as an indicator of cytosolic enzyme release and cytotoxicity. Acetazolamide at 100 μM completely inhibited PTH-induced bone resorption. This inhibition did not appear to be due to cell death, as acetazolamide did not increase lactate dehydrogenase release. Acetazolamide had no effect on PTH-enhanced cAMP levels, indicating that receptor binding and adenylate cyclase activation were unaffected. Acetazolamide alone did not alter calvarial protein synthesis, but did significantly inhibit protein synthesis in the presence of PTH. PTH significantly enhanced calvarial glucose utilization, lactic acid release, and β-glucuronidase release. Acetazolamide inhibited all of these PTH-induced parameters in a manner that roughly paralleled its inhibition of bone resorption; acetazolamide alone had no effect on the basal values. Our results indicate that acetazolamide inhibition of bone resorptionin vitro may involve general alterations in hormonally stimulated bone cell metabolism secondary to carbonic anhydrase inhibition.     

The headless bone scan: an uncommon manifestation of metastatic superscan in carcinoma of the prostate

Five cases of metastatic prostatic carcinoma are presented. In each case, skeletal metastases were extensive, but the calvaria was not involved, resulting in a headless appearance. The mechanism for this scintigraphic manifestation is presented, and its value is emphasized.     

Biomechanics of the calvarium

Summary The authors question whether strengthening beams and spans for the calvarium really exist and, if so, what are their exact anatomic counterparts and their exact function in the resistance of the calvarium. They opine that this function is of secondary importance except for the frontal and internal occipital pillars. The resistance of the calvarium must rather be attributed to its sandwich structure, with local bracing where the constraints are too severe. While they believe in the existence of such braces as the occipital pillars between the calvarium and the endochondral skull base, they prefer the concept of the mastoid pillars. The mastoid process is a structure with a thin shell and alveolar content, which has the advantage of giving the sternocleidomastoid and digastric muscles a bigger area of attachment to a light structure.

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Biomécanique de la calvaria

Résumé Les auteurs se demandent s'il existe réellement des poutres et des travées de renforcement au niveau de la calvaria, quelle est, dans l'affirmative, leur correspondance anatomique exacte ainsi que leur rôle exact dans l'inertie de la calvaria. Ils estiment que ce rôle est secondaire hormis pour les piliers frontal et occipital interne. Pour eux, l'inertie de la calvaria doit être attribuée à sa « structure sandwich » avec, cependant, des renforts locaux là où il existe des sur-contraintes. S'ils croient bien à l'existence de certains renforts calvaria-chassis endochondral basicrânien, tels les piliers occipitaux, ils dénient toute réalité anatomique et mécanique au concept des piliers mastoïdiens, le processus mastoïdien étant une structure à « peau » mince et à remplissage aréolaire, dont l'avantage est de donner au m. sterno-cléido mastoïdien et au m. digastrique la plus grande aire d'insertion sur une structure légère.

     

The effectiveness of polyethylene versus titanium particles in inducing osteolysis in vivo.

Bearing surface wear and periprosthetic osteolysis due to wear particles are among the most common reasons for joint replacement failure. A murine calvarial model of wear particle-induced osteolysis has been used to identify different biologic factors associated with this problem and to test nonsurgical methods of modulating the host response to particulate debris. This model has utilized titanium particles, however, in clinical practice the most common source of particulate debris is polyethylene particles from bearing surface wear. We now report a calvarial model of wear particle-induced osteolysis based on commercially available polyethylene particles. We found that compared to sham surgery osteoclast recruitment and bone resorption can be induced by introduction of the titanium particles or polyethylene particles. However, bone resorption was significantly higher with polyethylene particles compared to titanium particles (p=0.02). We consider the polyethylene based murine calvarial model of wear particle-induced osteolysis a reliable and clinically relevant tool to understand the host factors and potential pharmacologic interventions that can influence wear debris generated osteolysis. This model might serve as an extension of the well-established titanium based bone resorption model.     

Multicentric infantile myofibromatosis: a rare disorder of the calvarium

Introduction  Infantile myofibromatosis is a rare mesenchymal disorder that occurs predominantly in infancy and early childhood, in either solitary or multicentric form. It can affect soft tissue, muscle, skeleton, and occasionally, visceral organs. Infantile myofibromatosis without visceral involvement frequently undergoes spontaneous regression. Multicentric infantile myofibromatosis with involvement exclusively of the calvarium is extremely rare. Discussion  We report an 8-month-old girl who presented with multifocal calvarial lesions. The child underwent total excision of the temporal mass, and histopathological study gave a diagnosis of infantile myofibromatosis. Serial follow-up by neuroimaging was obtained at 3, 6, 12, and 24 months postoperatively. Three months after surgery, a new lesion in the midline of frontal bone was found, and there was partial regression of the occipital lesion. Complete regression of the untreated lesions was shown at 24 months. Illustrated by our patient and literature review, we emphasize the importance of recognition and proper intervention for this rare, nonmalignant disorder.     

A Case of Calvarial Hemangioma in Cranioplasty Site

It is not uncommon for hemangiomas to occur in the calvarium, accounting for about 10% of the benign skull tumors. A 46-year-old man was presented with a palpable scalp mass on the left parietal region. Past medical history indicated that he had undergone cranioplasty 25 years prior due to a depressed skull fracture suffered from a traffic accident. Magnetic resonance imaging revealed mixed signal intensity mass on T1 -and T2-weighted images pushing a linear signal void lesion outward in the left parietal region. After total surgical removal along with cranioplasty, he was discharged without neurological deficits. Histological examination of the surgical specimen revealed a cavernous hemangioma. A skull hemangioma occurring at the site of a cranioplasty has not yet been reported. Therefore, authors report this case in combination with a pertinent literature review.