Large parietal midline defect with unusual ridge-like structure at the rim and persistent falcine sinus

Trigonocephaly and Cranium Bifidum Occultum Treated Simultaneously Using the Split-Bone Technique and Piezosurgery

Cranium bifidum occultum (CBO) is a rare congenital disease characterized by the anomalous ossification of parietal bones, which presents with a midline bone defect with no extrusion of intracranial content. Its association with craniosynostosis has been reported only a few times to date. The aim of this case report was to describe, for the first time, the association between presumed non-syndromic trigonocephaly and CBO, as well as the treatment of both conditions using the same surgical approach. This was done by performing fronto-orbital advancement and the split-bone technique using piezosurgery, in order to achieve an autologous sample to cover the bone defect. To the best of our knowledge, this approach was proven to be safe and able to treat both diseases without a heterologous bone graft.

Falcine Sinus: Incidence and Imaging Characteristics of Three-Dimensional Contrast-Enhanced Thin-Section Magnetic Resonance Imaging

Objective

To evaluate the incidence, characteristics, and variations of the falcine sinus with contrast-enhanced three-dimentional (3D) thin-section magnetic resonance (MR) images.

Materials and Methods

A retrospective review identified 1531 patients (745 males and 786 females, 2 months to 85 years) who underwent cranial MR imaging including T1-weighted imaging, T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, contrast-enhanced 3D thin-section sagittal scans, and MR venography, from June 2014 to January 2016. The incidence, characteristics of the falcine sinus, and coexisted intracranial lesions were confirmed by two neuroradiologists.

Results

Falcine sinuses were identified in 81 (38 males and 43 females) cases (5.3%, 81/1531, 5 months to 76 years of age) with calibers ranging from 2.3 mm to 17.0 mm. Three major forms of falcine sinuses were defined: arch-like (n = 47), stick-like (n = 22), and bifurcated (n = 12). Persistent falcine sinuses were found in 57 cases, among which 3 cases showed complicated cerebral anomalies, and 2 cases showed smaller straight sinuses. Recanalization of falcine sinuses were found in 24 cases, including 17 cases with tumor compression, 6 cases with cerebral venous sinus thrombosis, and one case with hypertrophic meningitis.

Conclusion

Falcine sinus is not as rare as has been reported previously. Most falcine sinuses are not associated with congenital cerebral abnormalities. Diseases that cause increased pressure in the venous sinus may lead to recanalization of falcine sinus. Illustrating the characteristics of falcine sinus may prompt a more comprehensive understanding and diagnosis of associated diseases, and avoid potential surgical damage in the future.

Single-site neural tube closure in human embryos revisited

Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc.

Cranium Bifidum Occultum Associated with Hypertelorism Treated with Posterior Vault Reconstruction and Orbital Box Osteotomies: Case Report and Technical Note

Cranium bifidum occultum is a disorder of skull ossification presenting as an enlarged posterior fontanelle in the upper posterior angle of the parietal bone near the intersection of the sagittal and lambdoid sutures. The standard treatment for cranium bifidum occultum is observation. We present a case of a 5-year-old boy who presented with a 15 × 4.5 cm midline posterior cranial vault defect consistent with diagnosis of cranium bifidum occultum associated with orbital hypertelorism and a widened nose. The patient underwent posterior vault reconstruction for correction of cranium bifidum occultum defect followed by bifrontal craniotomy and orbital box osteotomies for correction of orbital hypertelorism and nasal deformity. To our knowledge, this is the first reported case describing surgical treatment for cranium bifidum occultum associated with orbital hypertelorism.

Congenital neurocristic tumor presenting as an isolated calvarial defect in an infant: case report

In infants, the presence of a cranial defect may be due to a variety of traumatic, inflammatory, neoplastic, and congenital abnormalities. Differentiation between these possible etiologies is facilitated by clinical presentation, patient history, and physical examination. Congenital cutaneous neural crest-derived lesions are unlikely to be considered in a patient presenting with an asymptomatic cranial defect without overlying mass or skin pigmentation. The authors present an unusual case of a 2-month-old infant with an asymptomatic calvarial defect with normal overlying skin. Pathology of the excised tissue showed features consistent with a congenital neurocristic tumor: a pigmented, neural crest-derived hamartomatous tumor that typically presents as a melanotic skin lesion.