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Machts R, Schindler M, Unterhauser-Chwastek H, Mertens J, Faust K. Pin penetration depths in the neurocranium using a three-pin head fixation device. Sci Rep 2024; 14:4726. [PMID: 38413760 PMCID: PMC10899659 DOI: 10.1038/s41598-024-55227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
In estimated 10-15% of neurosurgical interventions employing a conventional three-pin head fixation device (HFD) the patient's head loses position due to slippage. At present no scientifically based stability criterion exists to potentially prevent the intraoperative loss of head position or skull fractures. Here, data on the skull penetration depth both on the single and two-pin side of a three-pin HFD are presented, providing scientific evidence for a stability criterion for the invasive three-pin head fixation. Eight fresh, chemically untreated human cadaveric heads were sequentially pinned 90 times in total in a noncommercially calibrated clamp screw applying a predefined force of 270 N (approximately 60 lbf) throughout. Three head positions were pinned each in standardized manner for the following approaches: prone, middle fossa, pterional. Titanium-aluminum alloy pins were used, varying the pin-cone angle on the single-pin side from 36° to 55° and on the two-pin side from 25° to 36°. The bone-penetration depths were directly measured by a dial gauge on neurocranium. The penetration depths on the single-pin side ranged from 0.00 mm (i.e., no penetration) to 6.17 mm. The penetration depths on the two-pin side ranged from 0.00 mm (no penetration) to 4.48 mm. We measured a significantly higher penetration depth for the anterior pin in comparison to the posterior pin on the two-pin side in prone position. One pin configuration (50°/25°) resulted in a quasi-homogenous pin depth distribution between the single- and the two-pin side. Emanating from the physical principle that pin depths behave proportionate to pin pressure distribution, a quasi-homogenous pin penetration depth may result in higher resilience against external shear forces or torque, thus reducing potential complications such as slippage and depressed skull fractures. The authors propose that the pin configuration of 50°/25° may be superior to the currently used uniform pin-cone angle distribution in common clinical practice (36°/36°). However, future research may identify additional influencing factors to improve head fixation stability.
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Affiliation(s)
- René Machts
- Pro Med Instruments GmbH, Part of Black Forest Medical Group, 79111, Freiburg, Germany.
| | - Martina Schindler
- Pro Med Instruments GmbH, Part of Black Forest Medical Group, 79111, Freiburg, Germany
| | | | - Jan Mertens
- Pro Med Instruments GmbH, Part of Black Forest Medical Group, 79111, Freiburg, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine, 10117, Berlin, Germany
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Semple BD, Panagiotopoulou O. Cranial Bone Changes Induced by Mild Traumatic Brain Injuries: A Neglected Player in Concussion Outcomes? Neurotrauma Rep 2023; 4:396-403. [PMID: 37350792 PMCID: PMC10282977 DOI: 10.1089/neur.2023.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Mild traumatic brain injuries (TBIs), particularly when repetitive in nature, are increasingly recognized to have a range of significant negative implications for brain health. Much of the ongoing research in the field is focused on the neurological consequences of these injuries and the relationship between TBIs and long-term neurodegenerative conditions such as chronic traumatic encephalopathy and Alzheimer's disease. However, our understanding of the complex relationship between applied mechanical force at impact, brain pathophysiology, and neurological function remains incomplete. Past research has shown that mild TBIs, even below the threshold that results in cranial fracture, induce changes in cranial bone structure and morphology. These structural and physiological changes likely have implications for the transmission of mechanical force into the underlying brain parenchyma. Here, we review this evidence in the context of the current understanding of bone mechanosensitivity and the consequences of TBIs or concussions. We postulate that heterogeneity of the calvarium, including differing bone thickness attributable to past impacts, age, or individual variability, may be a modulator of outcomes after subsequent TBIs. We advocate for greater consideration of cranial responses to TBI in both experimental and computer modeling of impact biomechanics, and raise the hypothesis that calvarial bone thickness represents a novel biomarker of brain injury vulnerability post-TBI.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neuroscience, Monash University, Prahran, Victoria, Australia
- Department of Neurology, Alfred Health, Prahran, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Olga Panagiotopoulou
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
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Zhang J, Treyer V, Sun J, Zhang C, Gietl A, Hock C, Razansky D, Nitsch RM, Ni R. Automatic analysis of skull thickness, scalp-to-cortex distance and association with age and sex in cognitively normal elderly. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.19.524484. [PMID: 36711717 PMCID: PMC9882276 DOI: 10.1101/2023.01.19.524484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Personalized neurostimulation has been a potential treatment for many brain diseases, which requires insights into brain/skull geometry. Here, we developed an open source efficient pipeline BrainCalculator for automatically computing the skull thickness map, scalp-to-cortex distance (SCD), and brain volume based on T 1 -weighted magnetic resonance imaging (MRI) data. We examined the influence of age and sex cross-sectionally in 407 cognitively normal older adults (71.9±8.0 years, 60.2% female) from the ADNI. We demonstrated the compatibility of our pipeline with commonly used preprocessing packages and found that BrainSuite Skullfinder was better suited for such automatic analysis compared to FSL Brain Extraction Tool 2 and SPM12- based unified segmentation using ground truth. We found that the sphenoid bone and temporal bone were thinnest among the skull regions in both females and males. There was no increase in regional minimum skull thickness with age except in the female sphenoid bone. No sex difference in minimum skull thickness or SCD was observed. Positive correlations between age and SCD were observed, faster in females (0.307%/y) than males (0.216%/y) in temporal SCD. A negative correlation was observed between age and whole brain volume computed based on brain surface (females -1.031%/y, males -0.998%/y). In conclusion, we developed an automatic pipeline for MR-based skull thickness map, SCD, and brain volume analysis and demonstrated the sex-dependent association between minimum regional skull thickness, SCD and brain volume with age. This pipeline might be useful for personalized neurostimulation planning.
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Affiliation(s)
- Junhao Zhang
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
- Institute for Biomedical Engineering, ETH Zurich & University of Zurich, 8093 Zurich, Switzerland
| | - Valerie Treyer
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
- Department of Nuclear Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Junfeng Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Anton Gietl
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
| | - Christoph Hock
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
- Neurimmune, Schlieren, Switzerland
| | - Daniel Razansky
- Institute for Biomedical Engineering, ETH Zurich & University of Zurich, 8093 Zurich, Switzerland
| | - Roger M Nitsch
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
- Neurimmune, Schlieren, Switzerland
| | - Ruiqing Ni
- Institute for Regenerative Medicine, University of Zurich, 8952 Zurich, Switzerland
- Institute for Biomedical Engineering, ETH Zurich & University of Zurich, 8093 Zurich, Switzerland
- Zentrum für Neurowissenschaften Zurich, Zurich, Switzerland
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Rowbotham SK, Mole CG, Tieppo D, Blaszkowska M, Cordner S, Blau S. Reference measurements for average human neurocranial bone density to inform head trauma interpretations. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2141320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samantha K Rowbotham
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Calvin G Mole
- Department of Pathology, Division of Forensic Medicine and Toxicology, University of Cape Town, Cape Town, South Africa
| | - Diana Tieppo
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Magda Blaszkowska
- Centre for Forensic Anthropology, University of Western Australia, Perth, Australia
| | - Stephen Cordner
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Soren Blau
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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